Objectives: We studied daytime ambulatory systolic blood pressure in adults with coarctation to determine its relation to aortic obstruction and more extensive vascular dysfunction. Vascular function was examined by assessing central aortic, peripheral conduit arterial and resistance vessel function.
Methods: Twelve adult subjects (5native, 7 recoarctation) were studied before and 2-weeks and 6-months after aortic stenting. Systolic blood pressure was measured during normal daily living by 24-hour ambulatory monitoring. Central aortic function was assessed by pulse-wave analysis (augmentation index). Brachial artery flow-mediated dilatation and dilatation in response to 25mg of sublingual glyceryl-trinitrate was used to measure peripheral conduit arterial and resistance vessel function. Baseline vascular function was compared to twelve matched controls.
Results: Patients had higher augmentation index, impaired endothelium-dependent and independent dilatation, and forearm vascular resistance, (p<0.02). Following successful gradient relief by stenting, daytime ambulatory systolic blood pressure (151[134,166] vs 138[130,150], p=0.01) and the augmentation index (26[15,34] vs 23[13,30], p=0.03) fell progressively over 6 months, but did not completely normalise. Endothelium-dependent and independent dilatation, and forearm vascular resistance remained unchanged and impaired.
Conclusion: Relief of aortic obstruction and improvement is associated with improvement in central aortic function and results in reduction of daytime ambulatory systolic blood pressure. Peripheral vascular dysfunction however remains unchanged and may contribute to residual hypertension.
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