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Mid-term results, and therapeutic management, for patients suffering hypertension after surgical repair of aortic coarctation

Published online by Cambridge University Press:  13 August 2009

Ugo Giordano ,
Barbara Cifra ,
Salvatore Giannico ,
Attilio Turchetta  and
Armando Calzolari
Ugo Giordano*
Affiliation:
Cardiorespiratory and Sports Medicine Unit, Department of Pediatrics, Bambino Gesù Children’s Hospital, Rome, Italy
Barbara Cifra
Affiliation:
Cardiorespiratory and Sports Medicine Unit, Department of Pediatrics, Bambino Gesù Children’s Hospital, Rome, Italy
Salvatore Giannico
Affiliation:
Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
Attilio Turchetta
Affiliation:
Cardiorespiratory and Sports Medicine Unit, Department of Pediatrics, Bambino Gesù Children’s Hospital, Rome, Italy
Armando Calzolari
Affiliation:
Cardiorespiratory and Sports Medicine Unit, Department of Pediatrics, Bambino Gesù Children’s Hospital, Rome, Italy
*
Correspondence to: Ugo Giordano MD, Bambino Gesù Children’s Hospital, Piazza S. Onofrio 4-00165 – Rome - Italy. Tel: +390668592382; Fax: +390668592546; E-mail: giordano@opbg.net
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Abstract

We designed our study to investigate the efficacy of a new therapeutic approach to late onset hypertension in patients after surgical repair of aortic coarctation. Several studies have shown a higher incidence of hypertension during daily activities, and during exercise, in patients after surgical correction of coarctation. To the best of our knowledge, however, no data exists concerning haemodynamics, the response of arterial pressures, and the effects of medications for lowering blood pressure during exercise or during daily activities.

We studied 128 patients, aged 15.6 ± 4.3 years, to determine the response of blood pressure as we administered treatment in the attempt to achieve a normotensive state. We excluded patient with associated cardiac abnormalities, apart from those with bicuspid aortic valves. We evaluated blood pressure at rest in both the right arm and leg to establish presence of any gradient, as well as the blood pressure in the arm during exercise testing, and by 24-hour ambulatory monitoring.

Atenolol was prescribed for those with elevated values of blood pressure but with a normal increment of heart rate during exercise. We prescribed Candesartan for those with elevated levels of blood pressure but with reduced increments of heart rate, specifically maximal heart rates of less than 85% of their predicted value. Both drugs were used when one alone was not effective. We found that, in young patients, candesartan provided better control of blood pressure with no side-effects, especially as demonstrated using 24-hour ambulatory monitoring, while atenolol was less effective, with more side-effects. Our experience suggests that both drugs should be used in patients who are non-responsive to monotherapy.

Keywords

Congenital Heart DiseaseHigh blood pressureCandesartan
Type
Original Article
Information
Cardiology in the Young , Volume 19 , Issue 5 , October 2009 , pp. 451 - 455
Copyright
Copyright © Cambridge University Press 2009

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