Prognostic Role of Hypertensive Response to Exercise in Patients With Repaired Coarctation of Aorta

Vidhushei Yogeswaran, Heidi M. Connolly, Mohamad Al-Otaibi, Naser M. Ammash, Carole A. Warnes, Sameh M. Said, Alexander Egbe

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: This study aimed to determine the prevalence of hypertensive response to exercise (HRE) and its association with cardiovascular adverse events (CAEs) in patients with repaired coarctation of aorta (rCOA). Methods: We retrospectively reviewed records of adult patients with rCOA who had cardiopulmonary exercise tests (CPETs) and follow-up from 1994 to 2014 at Mayo Clinic. Patients with residual COA, defined as aortic isthmus peak velocity >2.5 m/s, were excluded. HRE was defined as peak systolic blood pressure >200 mm Hg; CAEs were defined as cardiovascular death, stroke, acute coronary syndrome, heart failure hospitalization, and left ventricular ejection fraction (LVEF) < 35%. Results: One hundred thirty-eight patients (82 men [59%]) underwent 213 CPETs, with follow-up of 85 ± 13 months. Age at initial COA repair was 9 ± 3 years; age at initial CPET was 40 ± 13 years. HRE occurred in 26 (19%) patients, and 24 (92%) of the patients with HRE had normal resting blood pressure. There were no differences in age, blood pressure at rest, and CPET findings between patients with HRE and those with normotensive response to exercise. There were 28 CAEs in 24 patients (17%), and HRE was an independent risk factor for CAE (hazard ratio [HR], 1.46 [1.13–2.52]; P = 0.04). Conclusions: HRE can occur even in the setting of normal blood pressure at rest, and it is a risk factor for CAE. We speculate that patients with HRE represent a high-risk group of patients who, presumably, have occult, advanced vascular dysfunction. CPET can identify these patients. The benefit of intensive antihypertension therapy needs to be confirmed.

Original languageEnglish (US)
Pages (from-to)676-682
Number of pages7
JournalCanadian Journal of Cardiology
Volume34
Issue number5
DOIs
StatePublished - May 1 2018

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Aortic Coarctation
Exercise
Exercise Test
Blood Pressure
Acute Coronary Syndrome
Stroke Volume
Blood Vessels
Hospitalization
Heart Failure
Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic Role of Hypertensive Response to Exercise in Patients With Repaired Coarctation of Aorta. / Yogeswaran, Vidhushei; Connolly, Heidi M.; Al-Otaibi, Mohamad; Ammash, Naser M.; Warnes, Carole A.; Said, Sameh M.; Egbe, Alexander.

In: Canadian Journal of Cardiology, Vol. 34, No. 5, 01.05.2018, p. 676-682.

Research output: Contribution to journalArticle

Yogeswaran, Vidhushei ; Connolly, Heidi M. ; Al-Otaibi, Mohamad ; Ammash, Naser M. ; Warnes, Carole A. ; Said, Sameh M. ; Egbe, Alexander. / Prognostic Role of Hypertensive Response to Exercise in Patients With Repaired Coarctation of Aorta. In: Canadian Journal of Cardiology. 2018 ; Vol. 34, No. 5. pp. 676-682.
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abstract = "Background: This study aimed to determine the prevalence of hypertensive response to exercise (HRE) and its association with cardiovascular adverse events (CAEs) in patients with repaired coarctation of aorta (rCOA). Methods: We retrospectively reviewed records of adult patients with rCOA who had cardiopulmonary exercise tests (CPETs) and follow-up from 1994 to 2014 at Mayo Clinic. Patients with residual COA, defined as aortic isthmus peak velocity >2.5 m/s, were excluded. HRE was defined as peak systolic blood pressure >200 mm Hg; CAEs were defined as cardiovascular death, stroke, acute coronary syndrome, heart failure hospitalization, and left ventricular ejection fraction (LVEF) < 35{\%}. Results: One hundred thirty-eight patients (82 men [59{\%}]) underwent 213 CPETs, with follow-up of 85 ± 13 months. Age at initial COA repair was 9 ± 3 years; age at initial CPET was 40 ± 13 years. HRE occurred in 26 (19{\%}) patients, and 24 (92{\%}) of the patients with HRE had normal resting blood pressure. There were no differences in age, blood pressure at rest, and CPET findings between patients with HRE and those with normotensive response to exercise. There were 28 CAEs in 24 patients (17{\%}), and HRE was an independent risk factor for CAE (hazard ratio [HR], 1.46 [1.13–2.52]; P = 0.04). Conclusions: HRE can occur even in the setting of normal blood pressure at rest, and it is a risk factor for CAE. We speculate that patients with HRE represent a high-risk group of patients who, presumably, have occult, advanced vascular dysfunction. CPET can identify these patients. The benefit of intensive antihypertension therapy needs to be confirmed.",
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AU - Ammash, Naser M.

AU - Warnes, Carole A.

AU - Said, Sameh M.

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AB - Background: This study aimed to determine the prevalence of hypertensive response to exercise (HRE) and its association with cardiovascular adverse events (CAEs) in patients with repaired coarctation of aorta (rCOA). Methods: We retrospectively reviewed records of adult patients with rCOA who had cardiopulmonary exercise tests (CPETs) and follow-up from 1994 to 2014 at Mayo Clinic. Patients with residual COA, defined as aortic isthmus peak velocity >2.5 m/s, were excluded. HRE was defined as peak systolic blood pressure >200 mm Hg; CAEs were defined as cardiovascular death, stroke, acute coronary syndrome, heart failure hospitalization, and left ventricular ejection fraction (LVEF) < 35%. Results: One hundred thirty-eight patients (82 men [59%]) underwent 213 CPETs, with follow-up of 85 ± 13 months. Age at initial COA repair was 9 ± 3 years; age at initial CPET was 40 ± 13 years. HRE occurred in 26 (19%) patients, and 24 (92%) of the patients with HRE had normal resting blood pressure. There were no differences in age, blood pressure at rest, and CPET findings between patients with HRE and those with normotensive response to exercise. There were 28 CAEs in 24 patients (17%), and HRE was an independent risk factor for CAE (hazard ratio [HR], 1.46 [1.13–2.52]; P = 0.04). Conclusions: HRE can occur even in the setting of normal blood pressure at rest, and it is a risk factor for CAE. We speculate that patients with HRE represent a high-risk group of patients who, presumably, have occult, advanced vascular dysfunction. CPET can identify these patients. The benefit of intensive antihypertension therapy needs to be confirmed.

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