Key result
Resting normotensive patients post-coarctation repair show ~7 mmHg higher 24-hour systolic BP than healthy controls.
Why the study?
Patients normotensive at rest after successful surgical repair of coarctation of the aorta may have subtle blood pressure abnormalities detectable by ambulatory monitoring at mid-term follow-up.
Do patients with normotension at rest after successful surgical repair of coarctation of the aorta have abnormal ambulatory blood pressure profiles compared to matched controls?
Case-Control (n=36)
No
Do patients with normotension at rest after successful surgical repair of coarctation of the aorta have abnormal ambulatory blood pressure profiles compared to matched controls?
Absolute Event Rate: 115% vs 108%
p-value: p=0.04
Even when normotensive at rest, children with successfully repaired coarctation of the aorta exhibit higher ambulatory systolic blood pressures and increased left ventricular mass index compared to healthy controls, highlighting the utility of ambulatory monitoring.
ABPM may detect BP variability missed at rest after coarctation repair; hypothesis-generating for risk stratification, needs prospective validation.
Variations of systolic and diastolic blood pressure in patients with normotension at rest after successful surgical repair of coarctation of the aorta were examined using 24 hour ambulatory monitoring at mid-term follow-up. Ambulatory blood pressure monitoring, m-mode measurements of left ventricle and transmitral Doppler spectrals in 18 patients aged 7.6 +/- 4.5 years after 9 months to 6.1 years (2.5 +/- 1.9 years) following operation were compared with the findings in 18 matched controls. Patients had significantly higher mean systolic blood pressures (24 hours: 115 +/- 10 mmHg, awake: 119 +/- 11 mmHg and asleep: 106 +/- 8 mmHg) than controls (24 hours: 108 +/- 6 mmHg, awake: 112 +/- 7 mmHg and asleep: 101 +/- 7 mmHg) (p = 0.04, 0.03 and 0.03, respectively). Patients had also more systolic blood pressure readings above the 95th percentile for age (24 hours: 28 +/- 20%, awake: 39 +/- 27% and asleep: 12 +/- 14%) than controls (24 hours: 10 +/- 9%, awake: 14 +/- 13% and asleep: 1 +/- 4%) (p = 0.03, 0.002 and 0.007, respectively). No significant difference was found in diastolic blood pressure profiles. There were no significant differences in left ventricular m-mode measurements and diastolic function parameters. Left ventricular mass index was significantly increased in patients (81.7 +/- 28.7 g/m2) compared with controls (64.5 +/- 20.9 g/m2) (p = 0.03). Operation age and post-surgical period did not affect ambulatory blood pressure profiles at mid-term follow-up. Patients who are normotensive at rest after successful surgical repair of coarctation of the aorta show higher systolic blood pressure profiles than healthy children with ambulatory blood pressure monitoring at mid-term follow-up. Ambulatory blood pressure monitoring in patients operated on for coarctation of the aorta despite their good clinical status is useful to detect and monitor subtle abnormalities of blood pressure.
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Ayse Guller EROGLU (2000) conducted a case-control in Coarctation of the aorta (post-repair) (n=36). History of successful surgical repair of coarctation of the aorta vs. Healthy matched controls was evaluated on Mean 24-hour systolic blood pressure (p=0.04). Patients who were normotensive at rest after successful surgical repair of coarctation of the aorta had significantly higher mean 24-hour systolic blood pressure compared to healthy controls (115 vs 108 mmHg, p=0.04).
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