Blood pressure pattern and variability in adult patients after successful repair of coarctation of the aorta in adults

Abstract

Background Abnormal 24-h blood pressure profile is a frequent finding in patients with secondary forms of hypertension. It correlates with severity of end-organ damage in hypertensive patients. One can make hypothesis that increased incidence of end-organ damage in patients after a successful operation of coarctation of the aorta is connected with abnormal 24-h blood pressure profile caused by hemodynamic abnormalities due to recurrent aortic obstruction or hypertensive disease.
The aim of the study was to evaluate 24-h blood pressure pattern and variability in adult patients long after successful surgical, having normal (group CoA CP) or increased (group CoA NT) blood pressure in comparison with patients with primary hypertension (group NTP).
Material and methods Thirty two patients after a successful operation of coarctation of the aorta were studied. Control group consisted of 20 NTP patient. We found 11 CoA NT patients and 21 CoA CP patients among those with coarctation of the aorta.
Blood pressure was measured traditionally and 24-h ABPM was performed in all patients. Based on it nocturnal blood pressure fall (NBPF) and blood pressure variability (BPV) was calculated. Patients were classified as dippers and nondippers according to extend of NBPF (threshold - 10 %).
Results Forty four % patients in CoA CP group, 73% patients in CoA NT group and 20% patients in NTP group were nondippers. Systolic NBPF was significantly impaired in CoA NT patients in comparison with CoA CP and NTP patients, while diastolic NBPF was significantly smaller in both CoA NT and CoA CP patients in comparison with NTP patients.
Systolic BPV was 7.8 ± 1.9 mm Hg in CoA CP group and was significantly lower than in CoA NT and NTP groups (11.8 ± mm Hg and 12.3 ± 2.3 mm Hg respectively). Diastolic BPV in CoA CP group (7.3 ± 1.6 mm Hg) was significantly lower than in NTP group (10.4 ± 2.3 mm Hg) but insignificantly in comparison with CoA NT group (9.2 ± 2.1 mm Hg).
Conclusions 1. Patients after successful surgical repair of coarctation of the aorta, especially those with hypertension, have blunted nocturnal blood pressere fall and are more frequently classified as non-dippers in comparison with patients with primary hypertension. 2. BPV is increased in CoA NT patients in comparison with CoA CP patients, but to the same extent as with NTP patients. 3. It seems that abnormalities of 24-h blood pressure in patients after operation of coarctation of the aorta are connected both with hemodynamic changes due recurrent aortic obstruction and presence of hypertension.