Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Atenolol vs enalapril in young hypertensive patients after successful repair of aortic coarctation

Abstract

Late arterial hypertension has been identified as a major predictor for morbidity and mortality in aortic coarctation (AoC) patients. Few data are available about efficacy and tolerability of angiotensin converting enzyme inhibitors vs beta-blockers in young AoC patients. This study aimed to evaluate the tolerability and efficacy on 24-h blood pressure (BP) and left ventricular mass/height2.7 (LVMI), of atenolol vs enalapril. We enrolled consecutive AoC hypertensive patients with (a) no history of BP treatment or after >48 h of withdrawn, (b) aged 6–20 years, (c) body mass index (BMI) <90th percentile for age and sex, (d) >12 months from a successful AoC repair and (e) no major associated cardiovascular abnormalities. All patient were evaluated with 24-h ambulatory BP monitoring, standard echocardiography, strain–strain rate imaging, at enrolment, 3, 6 and 12 months of treatment. We studied 51 AoC patients (13±3.9 years, BMI: 21.4±4.3 kg m–2). Patients were randomly assigned at atenolol treatment (n=26), or enalapril treatment (n=25). The mean follow-up duration was 11±2 months. Both drugs were able to significantly reduce 24-systolic BP (SBP; atenolol: 133±11 mm Hg vs 124±16 mm Hg, P=0.016; enalapril: 135±6 mm Hg vs 127±7 mm Hg, P=0.001). Only enalapril was able to significantly reduce LVMI (47±12 vs 39.6±10 g m2.7, P=0.016). Only in atenolol group in two cases (7.7%) drug withdrawal was needed because of adverse events. Enalapril and atenolol are similarly effective in reducing SBP. However, only enalapril demonstrated a significant reduction of LVMI. In no case, enalapril was stopped because of adverse events.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. De Divitiis M, Rubba P, Calabrò R . Arterial hypertension and cardiovascular prognosis after successful repair of aortic coarctation: a clinical model for the study of vascular function. Nutr Metab Cardiovasc Dis 2005; 15 (5): 382–394.

    Article  Google Scholar 

  2. Cohen M, Fuster V, Steele PM, Driscoll D, McGoon DC . Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation 1989; 80: 840–845.

    Article  CAS  Google Scholar 

  3. De Divitiis M, Pilla C, Kattenhorn M, Donald A, Zadinello M, Wallace S et al. Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta. J Am Coll Cardiol 2003; 41 (12): 2259–2265.

    Article  Google Scholar 

  4. Moltzer E, Mattace Raso FUS, Karamermer Y, Boersma E, Webb GD, Simoons ML et al. Comparison of candesartan versus metoprolol for treatment of systemic hypertension after repaired aortic coarctation. Am J Cardiol 2010; 105: 217–222.

    Article  CAS  Google Scholar 

  5. Giordano U, Cifra B, Giannico S, Turchetta A, Calzolari A . Mid-term results, and therapeutic management, for patients suffering hypertension after surgical repair of aortic coarctation. Cardiol Young 2009; 19: 451–455.

    Article  Google Scholar 

  6. Wühl E, Witte K, Soergel M, Mehls O, Schaefer F . Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 2002; 20: 1995–2007.

    Article  Google Scholar 

  7. Flynn JT, Daniels SR . Progress pharmacologic treatment of hypertension in children and adolescents. J Pediatr 2006; 149: 746–754.

    Article  CAS  Google Scholar 

  8. Rosner B, Cook N, Portman R, Daniels S, Falkner B . Determination of blood pressure percentiles in normal-weight children: Some methodological issues. Am J Epidemiol 2008; 167: 653–666.

    Article  CAS  Google Scholar 

  9. Tedesco MA, Di Salvo G, Ratti G, Natale F, Calabrese E, Grassia C et al. Arterial distensibility and ambulatory blood pressure monitoring in young patients with neurofibromatosis type 1. Am J Hypertens 2001; 14 (6 Pt 1): 559–566.

    Article  CAS  Google Scholar 

  10. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114 (2 Suppl 4th Report): 555–576.

    Article  Google Scholar 

  11. De Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20: 1251–1260.

    Article  CAS  Google Scholar 

  12. Khoury PR, Mitsnefes M, Daniels SR, Kimball TR . Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 2009; 22: 709–714.

    Article  Google Scholar 

  13. Di Salvo G, Eyskens B, Claus P, D’hooge J, Bijnens B, Suys B et al. Late post-repair ventricular function in patients with origin of the left main coronary artery from the pulmonary trunk. Am J Cardiol 2004; 93 (4): 506–508.

    Article  Google Scholar 

  14. Di Salvo G, Pacileo G, Del Giudice EM, Natale F, Limongelli G, Verrengia M et al. Abnormal myocardial deformation properties in obese, non-hypertensive children: an ambulatory blood pressure monitoring, standard echocardiographic, and strain rate imaging study. Eur Heart J 2006; 27 (22): 2689–2695.

    Article  Google Scholar 

  15. Edwards IR, Aronson JK . Adverse drug reactions: definitions, diagnosis, and management. Lancet 2000; 356: 1255–1259.

    Article  CAS  Google Scholar 

  16. Tedesco MA, Ratti G, Aquino D, Limongelli G, di Salvo G, Mennella S et al. Effects of losartan on hypertension and left ventricular mass: a long-term study. J Hum Hypertens 1998; 12: 505–510.

    Article  CAS  Google Scholar 

  17. Freed MD, Rocchini A, Rosenthal A, Nadas AS, Castaneda AR . Exercise-induced hypertension after surgical repair of coarctation of the aorta. Am J Cardiol 1979; 43: 253–258.

    Article  CAS  Google Scholar 

  18. James FW, Kaplan S . Systolic hypertension during sub- maximal exercise after correction of coarctation of the aorta. Circulation 1973; 50 (2 Suppl): II27–II34.

    Google Scholar 

  19. Daniels SR, James FW, Loggie JM, Kaplan S . Correlates of resting and maximal exercise systolic blood pressure after repair of coarctation of the aorta: a multivariable analysis. Am Hear J 1987; 113: 349e53.

    Article  Google Scholar 

  20. O’Sullivan JJ, Derrick G, Darnell R . Prevalence of hypertension in children after early repair of coarctation of the aorta: a cohort study using casual and 24 h blood pressure measurement. Heart 2002; 88: 163–166.

    Article  Google Scholar 

  21. Bald M, Neudorf U . Arterial hypertension in children and adolescents after surgical repair of aortic coarctation defined by ambulatory blood pressure monitoring. Blood Press Monit 2000; 5: 163–167.

    Article  CAS  Google Scholar 

  22. Verdecchia P . Prognostic value of ambulatory blood pressure. Current evidence and clinical implications. Hypertension 2000; 35: 844–851.

    Article  CAS  Google Scholar 

  23. Liu JE, Roman MJ, Pini R, Schwartz JE, Pickering TG, Devereux R . Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med 1999; 131: 564–572.

    Article  CAS  Google Scholar 

  24. Verdecchia P, Carini G, Circo A, Dovellini E, Giovannini E, Lombardo M et al. Left ventricular mass and cardiovascular morbidity in essential hypertension: the MAVI study. J Am Coll Cardiol 2001; 38 (7): 1829–1835.

    Article  CAS  Google Scholar 

  25. Mancia G, Zanchetti A, Agabiti-Rosei E, Benemio G, De Cesaris R, Fogari R et al. Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertophy. SAMPLE Study Group. Study on Ambulatory Monitoring of Blood Pressure and Lisinopril Evaluation. Circulation 2001; 95: 1464–1470.

    Article  Google Scholar 

  26. Dahlof B, Pennert K, Hansson L . Reversal of left ventricular hypertrophy in hypertensive patients a metaanalysis of 109 treatment studies. Am J Hypertens 1992; 5: 95–110.

    Article  CAS  Google Scholar 

  27. Huysman JAN, Vliegen HW, Van der Laarse A, Eulderink F . Changes in nonmyocyte tissue composition associated with pressure overload of hypertrophic human hearts. Pathol Res Pract 1989; 184: 577–581.

    Article  CAS  Google Scholar 

  28. Lam YY, Mullen MJ, Kaya MG, Gatzoulis MA, Li W, Henein MY . Left ventricular long axis dysfunction in adults with ‘corrected’ aortic coarctation is related to an older age at intervention and increased aortic stiffness. Heart 2009; 95: 733–739.

    Article  Google Scholar 

  29. Henein MY, Gibson DG . Long axis function in disease. Heart 81: 229–231.

  30. Di Salvo G, Pacileo G, Limongelli G, Verrengia M, Rea A, Santoro G et al. Abnormal regional myocardial deformation properties and increased aortic stiffness in normotensive patients with aortic coarctation despite successful correction: an ABPM, standard echocardiography and strain rate imaging study. Clin Sci (Lond) 2007; 113: 259–266.

    Article  Google Scholar 

  31. Sutherland GR, Di Salvo G, Claus P, D’hooge J, Bijnens B . Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr 2004; 17 (7): 788–802.

    Article  Google Scholar 

Download references

Acknowledgements

This study was funded by the Italian Agency of Drugs (AIFA) (FARM6HCEM5).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to G Di Salvo.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Di Salvo, G., Castaldi, B., Gala, S. et al. Atenolol vs enalapril in young hypertensive patients after successful repair of aortic coarctation. J Hum Hypertens 30, 363–367 (2016). https://doi.org/10.1038/jhh.2015.87

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2015.87

This article is cited by

Search

Quick links