Vol 7, No 4 (2003)
Original paper
Published online: 2003-09-24
Incidence of Hypertension and Effectivness of Antihypertensive Treatment in Adult Patients after Successful Repair of Coarctation of the Aorta
Nadciśnienie tętnicze 2003;7(4):245-252.
Abstract
Background Longitudinal observation of patients after a successful operation of coarctation of the aorta shows that surgical repair does not treat arterial hypertension. The guidelines of antihypertensive treatment in this group have not been univocally established. The aim of the study was to determine the frequency
of occurrence of arterial hypertension and the analysis of efficacy of antihypertensive treatment in patients after successful surgical repair of coarctation of the aorta in grown-up congenital heart disease ambulatory.
Material and methods We analyzed 93 patients age 17–59 years (the mean age was 29.87 ± 9.72) after a successful operation of the coarctation of the aorta. During control visit blood pressure was measured at rest with the use of mercury sphygmomanometer and current antihypertensive treatment was evaluated. These data were analyzed retrospectively comparing to the blood pressure during the first visit or the visit during which arterial hypertension was diagnosed. Antihypertensive treatment was also analyzed. The patients were observed in the period of 2 months to 5 years.
Results Arterial hypertension was observed in 50 patients (54%) of whom 32 were in stage I, 15 in stage II, and the remaining 3 in stage III according to WHO classification. Antihypertensive management was started with the use of β-blockers or ACE inhibitors in most of the patients. Monotherapy was maintained in 31 patients and 19 required combination therapy. A mean reduction of arterial blood pressure was 12/8 mm Hg. In patients treated with monotherapy blood pressure reduction (8/4 mm Hg) was significantly smaller (p < 0.0001) than in those treated with combination therapy (19/15 mm Hg). Normalization of blood pressure was achieved in 52% patients. The efficacy of monotherapy treatment was 32%, whereas in the group of combination therapy it reached 84%.
Conclusions 1. The prevalence of hypertension in adults after surgical repair of coarctation of the aorta is high and approximates to 50%. 2. Normalization of blood pressure in this group of patients treated by specialists can be achieved in half of the group. 3. Arterial hypertension in adults after surgical repair of coarctation of the aorta is not resistant to treatment, however, the effective control of blood pressure requires a frequent use of combination therapy.
Material and methods We analyzed 93 patients age 17–59 years (the mean age was 29.87 ± 9.72) after a successful operation of the coarctation of the aorta. During control visit blood pressure was measured at rest with the use of mercury sphygmomanometer and current antihypertensive treatment was evaluated. These data were analyzed retrospectively comparing to the blood pressure during the first visit or the visit during which arterial hypertension was diagnosed. Antihypertensive treatment was also analyzed. The patients were observed in the period of 2 months to 5 years.
Results Arterial hypertension was observed in 50 patients (54%) of whom 32 were in stage I, 15 in stage II, and the remaining 3 in stage III according to WHO classification. Antihypertensive management was started with the use of β-blockers or ACE inhibitors in most of the patients. Monotherapy was maintained in 31 patients and 19 required combination therapy. A mean reduction of arterial blood pressure was 12/8 mm Hg. In patients treated with monotherapy blood pressure reduction (8/4 mm Hg) was significantly smaller (p < 0.0001) than in those treated with combination therapy (19/15 mm Hg). Normalization of blood pressure was achieved in 52% patients. The efficacy of monotherapy treatment was 32%, whereas in the group of combination therapy it reached 84%.
Conclusions 1. The prevalence of hypertension in adults after surgical repair of coarctation of the aorta is high and approximates to 50%. 2. Normalization of blood pressure in this group of patients treated by specialists can be achieved in half of the group. 3. Arterial hypertension in adults after surgical repair of coarctation of the aorta is not resistant to treatment, however, the effective control of blood pressure requires a frequent use of combination therapy.
Keywords: coarctation of the aortaarterial hypertensionantihypertensive therapy