Simsolo R, Grunfeld B, Gimenez M, Lopez M, Berri G, Becú L, Barontini M
Sección Hipertensión Arterial, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina.
Am Heart J. 1988 Jun;115(6):1268-73. doi: 10.1016/0002-8703(88)90020-8.
The mechanisms responsible for long-term hypertension in children after successful repair of coarctation of the aorta have not yet been determined. We measured plasma renin activity and aldosterone, adrenalin, and noradrenalin concentrations both under basal conditions and in response to standing and treadmill exercise in 24 normal normotensive children, 16 normotensive postcoarctectomy children, eight hypertensive postcoarctectomy children, and seven children with essential hypertension. Exercise-induced changes in plasma renin activity, aldosterone, adrenalin, and noradrenalin were comparable in the four groups in spite of a significantly greater increase in systolic blood pressure in the children with hypertension. In response to standing, the plasma concentration of noradrenalin increased significantly in normotensive but not in hypertensive children. Hyperresponse of blood pressure to exercise in hypertensive postcoarctectomy children and children with essential hypertension is not related to abnormalities in the sympathetic nervous system or the angiotensin-aldosterone axis. Hypertension could be related to primary baroreceptor alterations, to structural changes in the arterial wall, or both. Twenty percent of normotensive postcoarctectomy children had a blood pressure hyperresponse to exercise and an abnormal noradrenalin response to standing similar to that seen in the hypertensive children. Follow-up of children after coarctectomy may elucidate whether these two abnormalities are indicators of an increased risk of developing long-term recurrent hypertension.
主动脉缩窄成功修复后儿童长期高血压的发病机制尚未明确。我们测定了24名血压正常的儿童、16名缩窄切除术后血压正常的儿童、8名缩窄切除术后高血压儿童以及7名原发性高血压儿童在基础状态下以及站立和跑步机运动后的血浆肾素活性、醛固酮、肾上腺素和去甲肾上腺素浓度。尽管高血压儿童的收缩压升高幅度明显更大，但四组中运动引起的血浆肾素活性、醛固酮、肾上腺素和去甲肾上腺素变化相当。站立时，血压正常儿童的血浆去甲肾上腺素浓度显著升高，而高血压儿童则不然。缩窄切除术后高血压儿童和原发性高血压儿童对运动的血压高反应与交感神经系统或血管紧张素 - 醛固酮轴的异常无关。高血压可能与原发性压力感受器改变、动脉壁结构变化或两者有关。20% 的缩窄切除术后血压正常的儿童对运动有血压高反应，对站立的去甲肾上腺素反应异常，类似于高血压儿童。对缩窄切除术后儿童的随访可能会阐明这两种异常是否是长期复发性高血压风险增加的指标。
