Abstract
Life expectancy is still reduced in aortic coarctation (AoC) patients despite a successful repair because of late arterial hypertension and atherosclerosis. Masked hypertension (MH) consists of an elevated daytime or awake ambulatory blood pressure (BP) in the presence of a normal BP on conventional measurement at the office. To assess the prevalence of MH among AoC normotensive young patients successfully treated and to evaluate the impact of MH on left ventricular (LV) geometry and function.We studied 76 AoC patients (mean age 14.5±5.7 years, male 64%). According to 24 h ambulatory BP monitoring (ABPM) our sample was divided in real normotensive patients (Group RN, n=40) and MH patients (Group MH, n=36). There was an increased pressure gradient in the aortic arch (15 mm Hg±4 vs 13 mm Hg±4.7, P<0.05), increased LV mass (51 g m−2.7±13 vs 46 g m−2.7±12, P<0.05), in MH AoC patients. Regional longitudinal deformation properties of the basal septal segment (−15%±2.4 vs −20%±5, P<0.01) and LV twist values (14°±1.6 vs 12°±1.9, P<0.0001) were reduced in the MH group. There is a high prevalence of MH in young patients with repaired AoC, which is associated with abnormal LV structure and function. Clinicians should consider 24 h ABPM measurements in apparently normotensive patients followed up for AoC repair.
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References
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.
Clarkson PM, Nicholson MR, Barratt-Boyes BG, Neutze JM, Whitlock RM . Results after repair of coarctation of the aorta beyond infancy: a 10 to 28 years follow-up with particular reference to late systemic hypertension. Am J Cardiol 1983; 81: 1541–1548.
Tanous D, Benson LN, Horlick EM . Coarctation of the aorta: evaluation and management. Curr Opin Cardiol 2009; 24: 509–515.
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: 382–394.
Lurbe E, Torro I, Alvarez V, Nawrot T, Paya R, Redon J et al. Prevalence, persistence, and clinical significance of masked hypertension in youth. Hypertension 2005; 45: 493–498.
Stergiou GS, Yiannes NJ, Rarra VC, Alamara CV . White-coat hypertension and masked hypertension in children. Blood Press Monit 2005; 10: 297–300.
Papadopoulos DP, Makris TK . Masked hypertension definition, impact, outcomes: a critical review. J Clin Hypertens (Greenwich) 2007; 9: 956–963.
Stabouli S, Kotsis V, Zakopoulos N . Ambulatory blood pressure monitoring and target organ damage in pediatrics. J Hypertens 2007; 25: 1979–1986.
Sethi A, Arora RR . Ambulatory blood pressure as a predictor of cardiovascular risk. Arch Med Sci 2009; 5: 3–9.
Kenny D, Polson JW, Martin RP, Wilson DG, Caputo M, Cockcroft JR et al. Surgical approach for aortic coarctation influences arterial compliance and blood pressure control. Ann Thorac Surg 2010; 902: 600–604.
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: 2259–2265.
de Divitiis M, Pilla C, Kattenhorn M, Zadinello M, Donald A, Leeson P et al. Vascular dysfunction after reapir of Coarctation of the aorta: impact of early surgery. Circulation 2001; 104: I165–I170.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.
National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Update on the 1987 Task Force Report on high blood pressure in children and adolescents: A working group report from the national high blood pressure education program. Pediatrics 1996; 98: 649–658.
Soergel M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R et al. Oscillometric 24-h blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 1997; 130: 178–184.
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.
Chinali M, de Simone G, Roman MJ, Lee ET, Best LG, Howard BV et al. Impact of obesity on cardiac geometry and function in a population of adolescents. The strong heart study. J Am Coll Cardiol 2006; 47: 2267–2273.
Takeuchi M, Borden WB, Nakai H, Nishikage T, Kokumai M, Nagakura T et al. Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy: a study using two-dimensional speckle tracking imaging. Eur Heart J 2007; 28: 2756–2762.
Beltman FW, Heesen WF, Smit AJ, Lie KI, Meyboom-de jong B . Acceptance and side effects of ambulatory blood pressure monitoring: Evaluation of new technology. J Hum Hypertens 1996; 10: 39–42.
Ou P, Bonnet D, Auriacombe L, Pedroni E, Balleux F, Sidi D et al. Late systemic hypertension and aortic arch geometry after successful repair of coarctation of the aorta. Eur Heart J 2004; 25: 1853–1859.
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: 788–802.
Narayanan A, Aurigemma GP, Chinali M, Hill JC, Meyer TE, Tighe DA . Cardiac mechanics in mild hypertensive heart disease: a speckle-strain imaging study. Circ Cardiovasc Imaging 2009; 2: 382–390.
Rüssel IK, Götte MJ, Bronzwaer JG, Knaapen P, Paulus WJ, van Rossum AC . Left ventricular torsion: an expanding role in the analysis of myocardial dysfunction. JACC Cardiovasc Imaging 2009; 2: 648–655.
Sengupta PP, Tajik AJ, Chandrasekaran K, Khandheria BK . Twist mechanics of the left ventricle: principles and application. JACC Cardiovasc Imaging 2008; 1: 366–376.
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We gratefully acknowledge the financial support from the Italian Medicines Agency (AIFA).
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Di Salvo, G., Castaldi, B., Baldini, L. et al. Masked hypertension in young patients after successful aortic coarctation repair: impact on left ventricular geometry and function. J Hum Hypertens 25, 739–745 (2011). https://doi.org/10.1038/jhh.2010.118
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DOI: https://doi.org/10.1038/jhh.2010.118
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