Article Text

Download PDFPDF
Exercise systolic blood pressures are of questionable value in the assessment of the adult with a previous coarctation repair
  1. L Swan1,
  2. S Goyal2,
  3. C Hsia2,
  4. S Hechter2,
  5. G Webb2,
  6. M A Gatzoulis1
  1. 1Adult Congenital Heart Programme, Royal Brompton Hospital, London, UK
  2. 2Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, Canada
  1. Correspondence to:
    Dr Lorna Swan, Toronto Congenital Cardiac Centre for Adults, 12th floor Eaton North, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada;


Background: The role of exercise testing in the follow up of adults with a coarctation repair is unclear. Exercise induced systolic hypertension has been advocated as an indication for further investigation; however, the value of exercise testing in this role has been questioned, especially in paediatric populations.

Objective: To assess the value of resting and exercise blood pressure measurements in a cohort of adults with repaired coarctation.

Setting: Tertiary referral centre for adult congenital cardiac disease.

Patients: 56 patients (33 male, 23 female) with a previous coarctation repair, and 33 age matched controls.

Main outcome measures: Resting and exercise blood pressures, including arm–leg systolic blood pressure gradients; standard echocardiographic measurements of left ventricular mass, aortic root diameter, and repair site gradient.

Results: The coarctation cohort had higher resting upper limb blood pressures than the controls (systolic: 129.7 v 120.7 mm Hg, p = 0.014; diastolic: 76.8 v 72.2 mm Hg, p = 0.02). Mean resting arm–leg systolic blood pressure gradient was also higher, at 3.6 v −2.2 mm Hg, p = 0.027. However, there were no differences between the peak exercise systolic blood pressures of the two groups. Peak exercise systolic blood pressure did not correlate with resting arm–leg blood pressure gradient (r = 0.24, p = 0.13) or with repair site gradient (r = 0.14, p = 0.39). Resting upper limb systolic blood pressure and resting arm–leg systolic blood pressure gradient were related to repair site gradient (r = 0.33, p = 0.03, and r = 0.47, p = 0.002).

Conclusions: Measurements of upper limb blood pressure during exercise are of limited value in the assessment of the post-repair coarctation patient. If routine exercise testing is to be advocated in this population it must be for another indication.

  • coarctation
  • blood pressure
  • exercise

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.