Exercise-induced hypertension after surgical repair of coarctation of the aorta*

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To study exercise-induced hypertension after surgical repair of coarctation of the aorta, 30 patients aged 6 to 30 years (median 14) were exercised to exhaustion on a treadmill using the Bruce protocol. Twenty patients with hemodynamically insignificant heart disease served as controls. Systolic blood pressure was measured simultaneously in the arm and leg before and immediately after exercise. There was no significant difference between the control and coarctectomy groups with regard to age at exercise, duration of exercise, maximal heart rate or serum lactate after exercise. Blood pressure in the arm increased significantly after exercise in both groups (control group: 110 [range 90 to 140] to 135 [range 114 to 164] mm Hg, P <0.001; coarctectomy group: 128 [range 104 to 154] to 187 [range 114 to 300] mm Hg, P <0.001) but was higher after exercise in the coarctectomy groups (P <0.001). Blood pressure in the leg increased in the control patients from 122 (range 94 to 160) to 135 (range 108 to 162) mm Hg (P <0.001) but was unchanged in the coarctectomy group. The difference between systolic pressure in the arm and leg in the patients with coarctectomy increased from 10 (range −22 to +55) at rest to 69 (range −6 to +205) mm Hg after exercise (P <0.001). The correlation was excellent between the systolic arm pressure and the difference between systolic pressures in the arm and leg after exercise (systolic arm pressure = 0.75 systolic gradient + 135) (r = 0.91, P <0.001).

This high correlation suggests that the residual obstruction across the site of the coarctectomy causes the observed postexercise systolic hypertension in the arm. Exercise testing with blood pressure measurements should be performed in all children after repair of coarctation of the aorta. In those whose postexercise systolic pressure in the arm exceeds 200 mm Hg, catheterization should be considered to measure central aortic pressure with exercise because reoperation, antihypertensive medication or restriction of severe physical effort may be necessary.

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*

This study was supported in part by Grants T 10 5855-07 and 5P01 HL 10436-08 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.

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