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Mechanisms underlying arterial hypertension in contemporary patients with repaired aortic coarctation: do we know enough?
  1. Julia Mascherbauer
  1. Correspondence to Dr Julia Mascherbauer, Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria; julia.mascherbauer{at}meduniwien.ac.at

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Identification, treatment and survival of patients with congenital heart disease have improved significantly over the past decades. Coarctation of the aorta is the fifth most common congenital heart defect, accounting for 6–8% of live births with congenital heart disease. Early-to-mid-term outcomes of patients with aortic coarctation are excellent, with early mortality rates as low as 2%. However, significant longer-term morbidity remains, particularly with respect to premature arterial hypertension. Although early surgery may prevent or delay the onset of hypertension, approximately 30% of coarctation patients will be hypertensive by adolescence despite early surgery and more recent reports observe that about 60% of adults after correction of aortic coarctation in childhood are hypertensive.1 These patients are at risk of premature coronary artery disease, left ventricular hypertrophy and systolic as well as diastolic dysfunction, and rupture of aortic or cerebral aneurysms. Most studies report resting blood pressure, but it is well established that a significant number of coarctation repair patients with normal resting blood pressure have an exaggerated blood pressure response to exercise which precedes the onset of overt hypertension.2

The mechanisms underlying arterial hypertension in corrected coarctation …

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