Cardiology in the Young

Original Articles

Predictors of exaggerated exercise-induced systolic blood pressures in young patients after coarctation repair

Peace C. Maduemea1 c1, Philip R. Khourya1, Elaine M. Urbinaa1 and Thomas R. Kimballa1

a1 The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America

Abstract

Background In normotensive subjects, an exaggerated blood pressure response to exercise is associated with the development of resting hypertension. We sought to determine the prevalence of elevated blood pressures during exercise in post-operative coarctation patients with normal resting blood pressure, and investigate associations with exercise-induced hypertension in this population.

Methods A total of 38 patients were enrolled after end-to-end anastomosis repair and resting normotension. All patients underwent anthropometric and blood pressure measurements, echocardiographic evaluation of function, arterial stiffness assessment by pulse wave velocity, and a graded exercise test. An abnormal response was defined as a maximum systolic blood pressure greater than the 95th percentile of published normal values. Correlation analyses and stepwise regression analyses were performed.

Results The mean age was 12.7 years, including 79% male patients. The mean resting systolic blood pressure was 111.3 millimetres of mercury and the mean exercise systolic blood pressure was 178.1 millimetres of mercury. The prevalence of a systolic blood pressure greater than the 95th percentile was 16.7%. In multivariate analysis, the exercise systolic blood pressure index was associated with body mass index, age, aortic valve annulus, shortening fraction, and pulse wave velocity (R2 equal to 0.79, p equal to 0.0009). Estimates of ventricular filling and indexed left ventricular mass were elevated.

Conclusions There is a risk of elevated systolic blood pressure during exercise in normotensive patients after coarctation repair. Resting blood pressures are useful but not sufficient. Echocardiography demonstrated abnormalities suggestive of a chronic cardiac burden despite resting normotension. Regular imaging may be necessary to improve long-term outcomes. New paradigms for the continued follow-up of these patients are necessary.

(Received December 02 2011)

(Accepted June 24 2012)

(Online publication September 12 2012)

Keywords

  • End-to-end resection;
  • exercise-induced hypertension;
  • pulse wave velocity;
  • graded exercise test

Correspondence

c1 Correspondence to: Dr P. C. Madueme, MD, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, Ohio 45229-3039, United States of America. Tel: (513) 636 3866; Fax: (513) 636 7468; E-mail: peace.madueme@cchmc.org