Key result
Balloon angioplasty for discrete aortic coarctation significantly reduced peak gradient (from 66 to 10.8 mmHg, P<0.0001) and normalized blood pressure without medication in 78% of patients.
Why the study?
Does balloon angioplasty improve systemic hypertension in adolescent and adult patients with coarctation of the aorta?
Cohort (n=53)
Does balloon angioplasty improve systemic hypertension in adolescent and adult patients with coarctation of the aorta?
Balloon angioplasty for discrete aortic coarctation provides excellent long-term relief of systemic hypertension, allowing the majority of patients to remain medication-free.
Answers are grounded in this paper and cite their sources.
May support angioplasty for hypertension relief in discrete coarctation; leaves open need for randomized trials versus stenting or surgery.
BACKGROUND: Little is known regarding the long-term follow-up results of balloon angioplasty (BA) for patients with aortic coarctation (AC) on systemic hypertension. HYPOTHESIS: To define the long-term effect of BA of AC on systemic hypertension in adolescent and adult patients. METHODS: Follow-up data of 53 patients (36 male), mean age 24 +/- 9 years, undergoing BA for discrete AC at median interval of 11.8 years (range, 4-18 years), including cardiac catheterization, magnetic resonance imaging (MRI), and echocardiography. Patients were divided into two groups at 1 year after BA on the basis of absence (group A: 40 patients) or presence (group B: 11 patients) of persistent hypertension and need for medication. RESULTS: Fifty-one patients had baseline hypertension, BA produced an immediate reduction in peak AC gradient from 66 +/- 23 mmHg to 10.8 +/- 7 mmHg (p < 0.0001). The immediate systolic blood pressure (SBP) decreased from 165 +/- 17 mmHg (95% CI: 159 to 171) to 125 +/- 10 mmHg (95% CI: 122 to 131) (p < 0.001) in 40 patients (group A) and from 184 +/- 19 mmHg (95% CI: 169 to 198) to 142 +/- 22 mmHg (95% CI: 124 to 156) (p<0.001) in 11 patients (group B). At 1-year follow-up, SBP decreased further to 115 +/- 10 in group A (95% CI 111-119) and 134 +/- 19 in group B (95% CI 122-142) (p<0.001). The blood pressure had normalized without medication in group A (165 +/- 17 to 115 +/- 10 mmHg). CONCLUSION: Long-term results of BA for discrete AC are excellent and should be considered as the first option for treatment of this disease. No paradoxical hypertension occurred post angioplasty, and normalization of blood pressure without medication occurred in 78% of the patients after BA.
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Hassan et al. (2007) conducted a cohort in aortic coarctation with systemic hypertension (n=53). Balloon angioplasty was evaluated on peak aortic coarctation gradient (p=<0.0001). Balloon angioplasty for discrete aortic coarctation significantly reduced peak gradient (from 66 to 10.8 mmHg, P<0.0001) and normalized blood pressure without medication in 78% of patients.
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