دانلود رایگان مقاله فشار خون بالا در بزرگسالان مبتلا به کوآرکتاسیون ترمیمی آئورت

Aims In adults with coarctation of the aorta (CoA), hypertension (HTN) is a common long-term complication. We investigated the prevalence of HTN and analyzed factors associated with HTN. Methods and results In the national register for congenital heart disease, 653 adults with repaired CoA were identified (mean age 36.9 ± 14.4 years); 344 (52.7%) of them had HTN, defined as either an existing diagnosis or blood pressure (BP) ≥140/90 mmHg at the clinical visit. In a multivariable model, age (years) (odds ratio [OR] 1.07, CI 1.05-1.10), sex (male) (OR 3.35, CI 1.98-5.68), and body mass index (kilograms per square meter) (OR 1.09, CI 1.03-1.16) were independently associated with having HTN, and so was systolic arm-leg BP gradient where an association with HTN was found at the ranges of (10, 20] and N20 mmHg, in comparison to the interval ≤10 mmHg (OR 3.58, CI 1.70-7.55, and OR 11.38, CI 4.03-32.11). This model remained valid when all patients who had increased BP (≥140/90 mmHg) without having been diagnosed with HTN were excluded from the analyses. Conclusions Hypertension is common in patients with previously repaired CoA and is associated with increasing age, male sex, and elevated body mass index. There is also an association with arm-leg BP gradient, starting at relatively low levels that are usually not considered for intervention. (Am Heart J 2016;181:1-6.)

Conclusions

Hypertension is common among patients with repaired CoA. In this relatively young population with a mean age of 37 years, 27 years after intervention, more than half of the patients had HTN, and there was an association with systolic arm-leg BP gradient as well as with BMI. Although calculated from noninvasive measurements, the clinically determined systolic arm-leg BP gradient may serve as an important predictor for HTN, and this appears to be true even for gradients below the currently recommended limit for reintervention. Thus, mild residual drops in pressure over the repaired coarctation may not be benign.