Blood Pressure Decrease Four Weeks After Interventional Treatment of Aortic Recoarctation Is Associated With Improved Vascular Remodeling

Objective: Patients who underwent correction of aortic coarctation as infants often develop recurrent stenosis of the aortic isthmus (aortic recoarctation) during adolescence, resulting in arterial hypertension. Aortic recoarctation often requires interventional treatment by means of catheter-based balloon dilatation or stent implantation in the re-stenosed section of the aortic isthmus. Patients with arterial hypertension frequently exhibit vascular remodelling, which is a predictor of cardiovascular events and increased mortality. This clinical study investigates how arterial blood pressure and vascular remodelling change in patients with aortic recoarctation following interventional treatment. Design and method: This single-center, prospective clinical study included 13 patients with aortic recoarctation (clinicaltrials.gov: NCT05903586). 8 patients had a fully available dataset and were included in this analysis. Office and 24-hour ambulatory BP were assessed together with vascular remodelling before and four weeks after interventional treatment. Vascular remodelling was measured non-invasively using pulse wave analysis including the parameters central systolic blood pressure and pulse pressure. In addition, retinal vascular remodelling was assessed using scanning laser Doppler flowmetry (SLDF). SLDF non-invasively measures vascular remodelling by using the retinal arterioles and capillaries as a mirror of the general circulation. SLDF allows confocal measurement of the retinal arteriolar parameters outer and inner diameter. Based on these two parameters arteriolar wall-to-lumen ratio, wall-thickness and cross-sectional area are calculated. Retinal vascular resistance is calculated using the quotient of mean arterial blood pressure and retinal capillary flow. Retinal capillary density is determined by using the parameters retinal intercapillary distance and retinal capillary density. Results: The patients had a mean age of 26 ± 12 years (one patient was 13 years old and the others were aged 17 years or older) and a mean baseline office BP of 136 ± 15/70 ± 10 mmHg. They were treated with one to two antihypertensive drugs. Antihypertensive medication remained stable throughout the study. Table 1 showed blood pressure and vascular parameters under office and 24-hour ambulatory conditions.Conclusions: Four weeks after interventional treatment of patients with aortic recoarctation we observed a blood pressure decrease under office and 24-hour ambulatory conditions which was associated with improved vascular remodelling.