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

Published online by Cambridge University Press:  12 September 2012

Peace C. Madueme ,
Philip R. Khoury ,
Elaine M. Urbina  and
Thomas R. Kimball
Peace C. Madueme*
Affiliation:
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Philip R. Khoury
Affiliation:
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Elaine M. Urbina
Affiliation:
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
Thomas R. Kimball
Affiliation:
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
*
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: [email protected]
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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.

Keywords

End-to-end resectionexercise-induced hypertensionpulse wave velocitygraded exercise test
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 3 , June 2013 , pp. 416 - 422
Copyright
Copyright © Cambridge University Press 2012 

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