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BP and vascular measures improve with coarctation relief
8 July 2008
MedWire News: Aortic stenting to relieve coarctation may improve blood pressure (BP) and vascular measures during daily life, UK researchers report.
But hypertension does not completely normalize after intervention, they add, possibly due to residual aortic wall abnormalities and persistent peripheral vascular dysfunction.
The team from University College London therefore emphasizes the need for continued surveillance in patients, even after successful relief of coarctation.
J Deanfield and co-workers examined the effect of mechanical aortic obstruction and vascular function on daytime ambulatory systolic BP by studying 12 adults with coarctation (five native, seven recoarctation).
Patients were assessed before aortic stenting and at 2 weeks and 6 months afterwards, and baseline vascular measures were compared with 12 control individuals.
Coarctation patients had a higher augmentation index, impaired brachial artery endothelium-dependent and -independent dilatation and forearm vascular resistance at baseline compared with control participants (p<0.02).
The gradient across the site of coarctation improved immediately after stenting, the researchers report in the journal Heart.
Daytime ambulatory systolic BP fell progressively from 151 mmHg at baseline to 138 mmHg at 6 months after stenting but did not completely normalize. The same was true for the augmentation index, which decreased from a baseline value of 26 to 23 at 6 months.
However, endothelium-dependent and -independent dilatation and forearm vascular resistance remained abnormal at 2 weeks and 6 months after stenting.
"We have shown that relief of coarctation (native or recoarctation) in adults leads to progressive improvement in blood pressure and vascular measures during normal daily life over a 6-month period," the researchers conclude.
They recommend: "Patients with hypertension and coarctation gradient should therefore be considered for stenting if clinically suitable."
