Intensive antihypertensive therapy vital in kids with arterial hypertension after CoA repair

Close blood pressure (BP) monitoring and more intensive and combined antihypertensive therapy are needed when there is a high prevalence of uncontrolled arterial hypertension (AH) despite the successful coarctation of the aorta (CoA) correction and use of relatively low doses of antihypertensive drugs, suggests a recent study.

A total of 110 children aged 6‒18 years were included in the analysis. Their BP status, echocardiographic parameters, and central BP measurements were assessed after the successful CoA repair, with right arm BP not exceeding leg BP by at least 20 mm Hg.

More than half of the patients (n=62; 56 percent) had AH, of whom 47 had already received treatment. Seven of 15 children with newly diagnosed AH and 10 of those already treated presented with masked hypertension. Isolated systolic hypertension was the dominant AH phenotype among those with uncontrolled AH (32 out of 37 patients; 87.5 percent).

Fifty-three percent of treated patients had their AH controlled. Among those with hypertension, 53 percent had elevated central systolic BP, 39 percent had left ventricular hypertrophy with various left ventricle geometry patterns, and 23 percent had both.

The most common antihypertensive medication was β-adrenergic receptor blocker, followed by angiotensin-converting enzyme inhibitors, with doses within the lower recommended range.

“Late (AH) is the most significant complication of CoA,” the authors said. “Only a few clinical studies described antihypertensive treatment of late AH following successful CoA repair.”