Hypertension in Coarctation of the Aorta: Challenges in Diagnosis in Children

Abstract

Evidence indicates that patients with coarctation of the aorta (COA) suffer from increased cardiovascular morbidity and mortality in later life despite successful repair of COA in childhood. Systolic arterial hypertension is common, presenting in up to one-third of patients, and is regarded as the main driver of premature cardiovascular events in this group of patients. In this review, we discuss the prevalence and pathophysiology of hypertension in children following successful COA repair with no residual arch obstruction. The challenges in accurate blood pressure assessment at this early phase are considered and non-invasive measures of central blood pressure are discussed. Although the pathways for investigations in adults are well defined, we highlight the need to address the issues of cardiovascular surveillance in children and describe techniques which can provide complementary information for cardiovascular assessment in this group of patients such that timely treatment can occur.

Is the burden of late hypertension and cardiovascular target organ damage in children and adolescents with coarctation of the aorta after early successful repair different to healthy controls?

“…Some of the previous studies have defined several clinical risk factors causing late hypertension such as older age at the time of repair, 4,33,34 longer duration of follow-up, and the type of surgery. 3,8 Age at repair is more favourable during infancy after first month of age. In the current study, there was no association between these clinical variables and blood pressure, which was probably due to the relatively homogenous distribution of these variables in our study population.…”

320-slice Computed Tomography Angiography Imaging Findings and Follow-up in A Patient with Aortic Coarctation Misdiagnosed as Hypertension: A Case Report and Literature Review

“…Medical treatment was ineffective, and the patient suffered from grade 2 hypertension. CoA is a notable cause of unexplained hypertension in adults [6].…”

Native aortic coarctation presenting as prolonged pyrexia in a teenager with 22q11.2 deletion

“…Despite the significant improvement in survival after CoA repair, patients have decreased survival and increased morbidity mainly due to chronic hypertension. Although early repair may delay the development of hypertension, about 30% of patients will be hypertensive in puberty . Yearly BP measurement at all four limbs, and regular echocardiographic imaging of the heart and aortic arch are paramount.…”

“…Yearly BP measurement at all four limbs, and regular echocardiographic imaging of the heart and aortic arch are paramount. Patient follow‐up should also include 24 h BP recordings and exercise testing, as hypertension is a negative prognostic factor for the development of hypertension in future and one third are hypertensive on exercise (systolic BP >200 mmHg) . Paediatricians should refer all patients to specialised grown‐up congenital heart disease centres after the age of 16 years for long‐term follow‐up.…”

“…Although early repair may delay the development of hypertension, about 30% of patients will be hypertensive in puberty. 8 Yearly BP measurement at all four limbs, and regular echocardiographic imaging of the heart and aortic arch are paramount. Patient follow-up should also include 24 h BP recordings and exercise testing, as hypertension is a negative prognostic factor for the development of hypertension in future and one third are hypertensive on exercise (systolic BP >200 mmHg).…”