Pelech A N, Kartodihardjo W, Balfe J A, Balfe J W, Olley P M, Leenen F H
Am Heart J. 1986 Dec;112(6):1263-70. doi: 10.1016/0002-8703(86)90358-3.
After repair of coarctation of the aorta, some patients with normal blood pressure at rest have an exaggerated hypertensive response to activity. Blood pressure response to exercise was studied in 15 children, aged 5 to 15 years, prior to and at periods up to 6 months following coarctectomy. Preoperatively, 11 of 15 children had systolic hypertension at rest and 12 of 15 after exercise. After surgery, only one child had mild systolic hypertension at rest, whereas exercise-induced hypertension persisted in 33% of patients (all older than 10 years). Exercise plasma renin activity was elevated preoperatively but normalized following surgery. No significant difference was seen in resting and exercise plasma catecholamine levels measured before and after surgery. Over the follow-up period of 6 months, echocardiographic evidence of left ventricular hypertrophy regressed in the younger patients but not in the older patients with exercise-induced hypertension. Exercise testing defines a subgroup of patients with exercise-induced hypertension evident soon after surgery. Structural upper segment arterial vessel wall changes in the older patient may explain these observations.
在主动脉缩窄修复术后，一些静息血压正常的患者对活动会出现过度的高血压反应。在15名年龄在5至15岁的儿童中，研究了主动脉缩窄切除术前及术后长达6个月期间运动时的血压反应。术前，15名儿童中有11名静息时出现收缩期高血压，15名中有12名运动后出现收缩期高血压。术后，只有1名儿童静息时出现轻度收缩期高血压，而33%的患者（均大于10岁）运动诱发的高血压持续存在。术前运动时血浆肾素活性升高，但术后恢复正常。手术前后测量的静息和运动时血浆儿茶酚胺水平无显著差异。在6个月的随访期内，年轻患者左心室肥厚的超声心动图证据有所消退，但运动诱发高血压的老年患者没有。运动测试确定了一组术后不久即出现运动诱发高血压的患者亚组。老年患者结构上半身动脉血管壁的变化可能解释了这些观察结果。
