TY - JOUR

T1 - High pulse pressure is not associated with abnormal activation of the renin-angiotensin-aldosterone system in repaired aortic coarctation

AU - Pedersen, T A L

AU - Pedersen, E B

AU - Munk, K

AU - Hjortdal, V E

AU - Emmertsen, K

AU - Andersen, N H

PY - 2015/4

Y1 - 2015/4

N2 - We investigated the relationship between pulse pressure (PP)--a surrogate marker of arterial stiffness-and activity of the renin-angiotensin-aldosterone system (RAAS) in adult patients with repaired coarctation and normal left ventricular (LV) function. A total of 114 patients (44 (26-74) years, 13 (0.1-40) years at repair) and 20 healthy controls were examined with 24-h ambulatory blood pressure monitoring, echocardiography, vasoactive hormone levels and magnetic resonance of the thoracic aorta. Forty-one patients (36%) were taking antihypertensives (28 RAAS inhibitors). Fifty-one had mean 24-h blood pressures >130/80 mm Hg. Hypertension was not associated with age at repair (P=0.257). Patients had higher PP and LV mass compared with controls (52±11 vs. 45±5 mm Hg and 221±71 vs. 154±55 g, respectively; both P<0.05). Differences were more pronounced in the presence of recoarctation, but independently of RAA levels. Even normotensive patients had higher LV mass than controls. LV mass and recoarctation were correlated with PP levels. In conclusion, adult patients with repaired coarctation have increased PP and LV mass compared with controls. PP increased with increasing recoarctation. Hypertension was present also in the absence of recoarctation. These changes could not be explained by abnormal activation of the RAAS.

AB - We investigated the relationship between pulse pressure (PP)--a surrogate marker of arterial stiffness-and activity of the renin-angiotensin-aldosterone system (RAAS) in adult patients with repaired coarctation and normal left ventricular (LV) function. A total of 114 patients (44 (26-74) years, 13 (0.1-40) years at repair) and 20 healthy controls were examined with 24-h ambulatory blood pressure monitoring, echocardiography, vasoactive hormone levels and magnetic resonance of the thoracic aorta. Forty-one patients (36%) were taking antihypertensives (28 RAAS inhibitors). Fifty-one had mean 24-h blood pressures >130/80 mm Hg. Hypertension was not associated with age at repair (P=0.257). Patients had higher PP and LV mass compared with controls (52±11 vs. 45±5 mm Hg and 221±71 vs. 154±55 g, respectively; both P<0.05). Differences were more pronounced in the presence of recoarctation, but independently of RAA levels. Even normotensive patients had higher LV mass than controls. LV mass and recoarctation were correlated with PP levels. In conclusion, adult patients with repaired coarctation have increased PP and LV mass compared with controls. PP increased with increasing recoarctation. Hypertension was present also in the absence of recoarctation. These changes could not be explained by abnormal activation of the RAAS.

KW - Adult

KW - Aged

KW - Antihypertensive Agents/therapeutic use

KW - Aorta, Thoracic/physiopathology

KW - Aortic Coarctation/complications

KW - Arterial Pressure/drug effects

KW - Biomarkers/blood

KW - Case-Control Studies

KW - Female

KW - Humans

KW - Hypertension/diagnosis

KW - Male

KW - Middle Aged

KW - Recurrence

KW - Renin-Angiotensin System/drug effects

KW - Risk Factors

KW - Time Factors

KW - Treatment Outcome

KW - Vascular Stiffness

KW - Ventricular Function, Left

U2 - 10.1038/jhh.2014.75

DO - 10.1038/jhh.2014.75

M3 - Journal article

C2 - 25355011

VL - 29

SP - 268

EP - 273

JO - Journal of Human Hypertension

JF - Journal of Human Hypertension

SN - 0950-9240

IS - 4

ER -