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Paradoxical increase in ambulatory SBP in coarctation of aorta a compared to essential hypertension
Alexander C Egbe1, William R Miranda, Likhita Shaik
1Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA.
Insights
Patients with coarctation of the aorta (COA) have higher ambulatory blood pressure (BP) and masked hypertension compared to essential hypertension. Office BP measurements may underestimate hypertension severity in COA patients.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Medicine
Background:
- Office blood pressure (BP) is typically lower than ambulatory BP in essential hypertension.
- Emerging data suggest office BP may underestimate arterial afterload in coarctation of the aorta (COA).
- COA patients exhibit exaggerated BP rise during exercise compared to essential hypertension patients.
Purpose of the Study:
- To investigate ambulatory BP and masked hypertension prevalence in COA patients versus essential hypertension.
- To compare arterial function indices between COA and essential hypertension groups.
Main Methods:
- A case-control study involving 118 COA patients and 118 essential hypertension patients.
- Participants were matched for age, sex, BMI, and office systolic BP (SBP).
Main Results:
- COA patients showed significantly higher 24-h and daytime ambulatory SBP despite similar office SBP.
- Reduced nocturnal dipping was observed in the COA group.
- Masked hypertension was more prevalent in COA patients (31%) compared to essential hypertension (12%), with worse arterial function.
Conclusions:
- Office SBP is a potentially unreliable measure for hypertension screening and monitoring in COA.
- Essential hypertension guidelines may not be directly applicable to COA treatment.
- Further research is warranted to explore ambulatory BP-guided pharmacologic interventions for COA outcomes.
Background:
The relationship between office vs. ambulatory blood pressure (BP) indices are well-studied in patients with essential hypertension and based on these data, it is known that the average 24-h ambulatory BP is typically lower than office BP. However, emerging data show that office SBP underestimates arterial afterload in patients with coarctation of aorta (COA), and a minimal increase in stroke volume during low-intensity exercise results in an exaggerated rise in SBP as compared to those with essential hypertension. We hypothesized that COA patients will have higher ambulatory SBP and a higher prevalence of masked hypertension compared to patients with essential hypertension.
Methods:
Case-control study of 118 COA patients and 118 patients with essential hypertension matched by age, sex, BMI and office SBP.
Results:
Although both groups had similar office SBP (132 ± 17 mmHg) by design, the COA group had paradoxical increases in 24-h ambulatory SBP (135 ± 14 vs. 126 ± 13; P < 0.001) and daytime ambulatory SBP (142 ± 16 vs. 130 ± 13; P < 0.001), and less nocturnal dipping (-3 ± 5 vs. -9 ± 4; P < 0.001). The COA group also had a higher prevalence of masked hypertension [36 (31%) vs 14 (12%); P < 0.001), and worse arterial function indices.
Conclusion:
These findings underscore the potential limitations of relying on office SBP for screening/monitoring of hypertension in COA and potential pitfalls in extrapolating essential hypertension guidelines recommendations to the treatment of COA. It also provides the rationale for further studies to determine if pharmacologic BP interventions guided by ambulatory BP data will improve clinical outcomes in the COA population.
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