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Blood pressure after repair of coarctation

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Adults who have had coarctation of the aorta repaired in childhood are at increased risk of hypertension compared with the general population. In most published follow up series the age at coarctation repair was quite high and it is known that late repair increases the risk of hypertension. Now data have been reported from a cohort in Newcastle upon Tyne (

) whose coarctations were repaired early.

From a cohort of 166 children born between 1983 and 1992 with coarctation of the aorta 119 survivors were followed up with full data. Mean age at repair was 0.2 years and at follow up 12 years. All were thought to have had a satisfactory repair. At follow up echocardiography 70 children were considered to have no arch obstruction and 49 mild obstruction. Of those with no arch obstruction 15 (21%) had a high (>95th centile) casual systolic blood pressure (mean of three readings) and 13 (19%) had a high mean 24 hour systolic blood pressure. For those with mild arch obstruction the corresponding figures were 19/49 (39%) and 23/49 (49%). High systolic blood pressure on casual readings was 66% sensitive and 88% specific for high mean 24 hour systolic blood pressure.

Systolic hypertension is common in later childhood after early repair of coarctation of the aorta even in the absence of significant residual arch obstruction. There is uncertainty about the need for treatment of this hypertension. Its cause also seems uncertain.

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