Institute of Clinical Medicine, Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
Clinic for Paediatric Cardiology and Cardiac Surgery, Children's Clinical University Hospital, Stradins University, Riga, Latvia.
Pediatr Nephrol. 2020 Nov;35(11):2147-2155. doi: 10.1007/s00467-020-04645-w. Epub 2020 Jun 11.
This study aimed to evaluate hemodynamic phenotypes and prevalence of left ventricular hypertrophy in children after coarctation repair with right arm and leg blood pressure difference < 20 mmHg. Secondary objectives were analysis of effects of age at intervention, residual gradient across the descending aorta, and type of correction.
Blood pressure status and left ventricular hypertrophy were diagnosed according to European Society of Hypertension 2016 guidelines.
Of 90 patients with a median age 12.5 (8.9-15.8) years, 8.5 (6.0-11.8) years after coarctation repair who were included, 42 (46.7%) were hypertensive. Isolated systolic hypertension dominated among 29 hypertensive patients with uncontrolled or masked hypertension (25 of 29; 86.2%). Of the 48 patients with office normotension, 14.6% (7) had masked hypertension, 8.3% (4) had ambulatory prehypertension, and 54.2% (26) were truly normotensive. Left ventricular hypertrophy was diagnosed in 29 patients (32.2%), including 14 of 42 (33.3%) hypertensive and 15 of 48 (31.3%) normotensive patients. The peak systolic gradient across the descending aorta was greater in hypertensive subjects (33.3 ± 12.7 mmHg) compared with normotensive subjects (25 ± 8.2 mmHg, p = 0.0008). Surgical correction was performed earlier than percutaneous intervention (p < 0.0001) and dominated in 40 of 48 (83.3%) normotensive versus 24 of 42 (57.1%) hypertensive patients (p = 0.006).
Arterial hypertension with isolated systolic hypertension as the dominant phenotype and left ventricular hypertrophy are prevalent even after successful coarctation repair. Coarctation correction from the age of 9 years and older was associated with a higher prevalence of hypertension.
本研究旨在评估臂腿血压差<20mmHg 的儿童在接受缩窄修复术后的血流动力学表型和左心室肥厚的发生率。次要目标是分析干预时的年龄、降主动脉残余梯度和矫正类型的影响。
根据欧洲高血压学会 2016 年指南诊断血压状况和左心室肥厚。
90 例患者的中位年龄为 12.5（8.9-15.8）岁，在接受缩窄修复术后 8.5（6.0-11.8）年，其中 42 例（46.7%）为高血压。在 29 例高血压患者中，孤立性收缩期高血压占主导地位，其中 25 例（29 例；86.2%）为未控制或隐匿性高血压。在 48 例办公室血压正常的患者中，有 14.6%（7 例）存在隐匿性高血压，8.3%（4 例）存在动态性高血压前期，54.2%（26 例）为真正的血压正常。诊断出左心室肥厚 29 例（32.2%），其中高血压患者 14 例（42 例；33.3%），血压正常患者 15 例（48 例；31.3%）。降主动脉收缩期峰值梯度在高血压患者中较大（33.3±12.7mmHg），而在血压正常患者中较小（25±8.2mmHg，p=0.0008）。手术矫正的时间早于经皮介入（p<0.0001），在 48 例血压正常患者中，40 例（83.3%）接受手术矫正，而在 42 例高血压患者中，24 例（57.1%）接受手术矫正（p=0.006）。
即使在成功的缩窄修复术后，仍存在以孤立性收缩期高血压为主的高血压和左心室肥厚。9 岁及以上年龄的缩窄矫正与高血压的高发生率相关。
