• Aortic Coarctation
• Hypertension

Coarctation of the aorta has long been considered a benign condition ‘cured’ by surgery but this is no longer the case. Large studies have demonstrated a significant reduction in long-term survival of patients with repaired coarctation even after ‘successful’ surgical repair, mostly due to the accelerated effects of hypertension and cardiovascular disease.1 We recently demonstrated an accelerated decline in long-term survival after only the third decade of life compared with a matched normal population.1 Therefore, it is imperative to identify early those at highest risk of developing hypertension and is why the recently published study by Meijs et al investigating the clinical and prognostic implications of a hypertensive response to exercise after coarctation repair has significant implications for this population.2

While resting blood pressure has long been the most used method for the detection of hypertension given its ease, we now know that it may underestimate the true prevalence of hypertensive disease in the repaired coarctation population. Up to 60% of patients with repaired coarctation may be diagnosed with hypertension on 24-hour ambulatory blood pressure monitoring (ABPM) with resting blood pressure measurements exhibiting a sensitivity of <50% in detecting an abnormal 24-hour blood pressure in this population.3 Consequently, in the recent 2020 European Society of Cardiology (ESC) guidelines, correct blood pressure measurement in the follow-up of patients with coarctation was defined as 24-hour ABPM on the right arm.4 However, 24-hour ABPM can be cumbersome and poorly tolerated in some patients, particularly children. Exercise stress testing has been increasingly explored in patients with coarctation to determine the prevalence, risk factors, and importantly, the prognostic implications of a hypertensive response to exercise in this population.

The multicentre, prospective registry study by Meijs …