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Congenital heart disease
Original research
Hypertensive response to exercise in adult patients with repaired aortic coarctation
  1. Timion A Meijs1,2,
  2. Steven A Muller1,
  3. Savine C S Minderhoud3,
  4. Robbert J de Winter2,
  5. Barbara J M Mulder2,
  6. Joost P van Melle4,
  7. Elke S Hoendermis4,
  8. Arie P J van Dijk5,
  9. Nicolaas P A Zuithoff6,
  10. Gregor J Krings7,
  11. Pieter A Doevendans1,8,9,
  12. Wilko Spiering10,
  13. Maarten Witsenburg3,
  14. Jolien W Roos-Hesselink3,
  15. Annemien E van den Bosch3,
  16. Berto J Bouma2,
  17. Michiel Voskuil1
  1. 1 Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
  2. 2 Department of Cardiology, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
  3. 3 Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
  4. 4 Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
  5. 5 Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
  6. 6 Department of Epidemiology and Biostatistics, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
  7. 7 Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
  8. 8 Netherlands Heart Institute, Utrecht, The Netherlands
  9. 9 Central Military Hospital, Utrecht, The Netherlands
  10. 10 Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
  1. Correspondence to Mr Timion A Meijs, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; t.a.meijs-5{at}umcutrecht.nl

Abstract

Objective The clinical and prognostic implications of a hypertensive response to exercise after repair of coarctation of the aorta (CoA) remain controversial. We aimed to determine the prevalence of a hypertensive response to exercise, identify factors associated with peak exercise systolic blood pressure (SBP) and explore the association of peak exercise SBP with resting blood pressure and cardiovascular events during follow-up.

Methods From the Dutch national CONgenital CORvitia (CONCOR) registry, adults with repaired CoA who underwent exercise stress testing were included. A hypertensive response to exercise was defined as a peak exercise SBP ≥210 mm Hg in men and ≥190 mm Hg in women. Cardiovascular events consisted of coronary artery disease, stroke, aortic complications and cardiovascular death.

Results Of the original cohort of 920 adults with repaired CoA, 675 patients (median age 24 years (range 16–72 years)) underwent exercise stress testing. Of these, 299 patients (44%) had a hypertensive response to exercise. Mean follow-up duration was 10.1 years. Male sex, absence of a bicuspid aortic valve and elevated resting SBP were independently associated with increased peak exercise SBP. Peak exercise SBP was positively predictive of office SBP (β=0.11, p<0.001) and 24-hour SBP (β=0.05, p=0.03) at follow-up, despite correction for baseline SBP. During follow-up, 100 patients (15%) developed at least 1 cardiovascular event. Peak exercise SBP was not significantly associated with the occurrence of cardiovascular events (HR 0.994 (95% CI 0.987 to 1.001), p=0.11).

Conclusions A hypertensive response to exercise was present in nearly half of the patients in this large, prospective cohort of adults with repaired CoA. Risk factors for increased peak exercise SBP were male sex, absence of a bicuspid aortic valve and elevated resting SBP. Increased peak exercise SBP independently predicted hypertension at follow-up. These results support close follow-up of patients with a hypertensive response to exercise to ensure timely diagnosis and treatment of future hypertension.

  • heart defects
  • congenital
  • aortic coarctation
  • hypertension

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/heartjnl-2021-320333

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Contributors Conception and design of the research: all authors. Data acquisition: TAM, SAM, SCSM, MV. Analysis and interpretation of the collected data: TAM, SAM, SCSM, JWR-H, AEvdB, BJB, MV. Drafting and/or critical appraisal of the manuscript: all authors. Approval of the final version: all authors. Guarantor: MV.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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