Ye Luisa, Castaldi Biagio, Cattapan Irene, Pozza Alice, Fumanelli Jennifer, Di Salvo Giovanni
Pediatric Cardiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy.
Front Cardiovasc Med. 2025 Apr 7;12:1505269. doi: 10.3389/fcvm.2025.1505269. eCollection 2025.
Aortic coarctation (AoC) is a common congenital heart defect, affecting 5%-8% of patients with structural congenital anomalies. Despite advances in surgical and percutaneous interventions, hypertension remains a significant complication in AoC patients, even after successful repair. Chronic hypertension develops in 20%-70% of patients and is a leading cause of long-term cardiovascular morbidity. In these patients, hypertension is associated to renin-angiotensin system activation, residual aortic arch abnormalities, and impaired aortic elasticity. Additionally, exercise-induced hypertension and masked hypertension contribute to adverse outcomes. Management of hypertension in AoC patients requires both perioperative and long-term care. Early after correction, intravenous antihypertensive agents, such as sodium nitroprusside, esmolol, and labetalol, are commonly used to stabilize blood pressure and reduce the risk of complications like cerebral hemorrhage. Oral beta-blockers, ACE inhibitors (ACE-Is), angiotensin receptor blockers (ARBs) and calcium channel blockers (CCBs) are most commonly used for chronic hypertension. In this review, we discussed about diagnostic workup and therapeutical strategies for hypertension in AoC patients.
主动脉缩窄（AoC）是一种常见的先天性心脏缺陷，在结构性先天性异常患者中占5%-8%。尽管手术和经皮介入治疗取得了进展，但高血压仍然是AoC患者的一个重要并发症，即使在成功修复后也是如此。20%-70%的患者会出现慢性高血压，这是长期心血管疾病的主要原因。在这些患者中，高血压与肾素-血管紧张素系统激活、残余主动脉弓异常以及主动脉弹性受损有关。此外，运动诱发的高血压和隐匿性高血压也会导致不良后果。AoC患者的高血压管理需要围手术期和长期护理。矫正后早期，常用静脉降压药物，如硝普钠、艾司洛尔和拉贝洛尔，来稳定血压并降低脑出血等并发症的风险。口服β受体阻滞剂、血管紧张素转换酶抑制剂（ACE-Is）、血管紧张素受体阻滞剂（ARBs）和钙通道阻滞剂（CCBs）最常用于治疗慢性高血压。在本综述中，我们讨论了AoC患者高血压的诊断检查和治疗策略。
