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Hypertension in aortic coarctation
Luisa Ye1, Biagio Castaldi1, Irene Cattapan1
1Pediatric Cardiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy.
Insights
Hypertension is a common complication after aortic coarctation repair. This review covers diagnostic and therapeutic strategies for managing blood pressure in these patients.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Vascular Medicine
Background:
- Aortic coarctation (AoC) is a prevalent congenital heart defect.
- Hypertension persists in 20%-70% of AoC patients post-repair, increasing cardiovascular risk.
- Factors contributing to hypertension include renin-angiotensin system activation and impaired aortic elasticity.
Purpose of the Study:
- To review diagnostic workup for hypertension in AoC patients.
- To discuss therapeutic strategies for managing hypertension in AoC patients, both perioperatively and long-term.
Main Methods:
- Literature review of diagnostic and therapeutic approaches for hypertension in AoC.
- Analysis of common antihypertensive agents used in perioperative and chronic management.
Main Results:
- Hypertension management requires both immediate post-correction care and long-term strategies.
- Intravenous agents (e.g., sodium nitroprusside, esmolol, labetalol) are used perioperatively.
- Oral medications including beta-blockers, ACE inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs) are common for chronic hypertension.
Conclusions:
- Effective management of hypertension is crucial for reducing long-term cardiovascular morbidity in AoC patients.
- A comprehensive approach to diagnosis and treatment is necessary for optimal patient outcomes.
Abstract:
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.
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