Clinical Research| Volume 34, ISSUE 5, P676-682, May 2018

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

Published:February 07, 2018DOI:



      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).


      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%.


      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).


      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.



      Cette étude visait à déterminer la prévalence de la réponse hypertensive à l’effort (RHE) ainsi que l’association entre cette réponse et les événements indésirables cardiovasculaires (EIC) chez des patients ayant subi une réparation d’une coarctation de l’isthme aortique (rCOA).


      Nous avons effectué un examen rétrospectif des dossiers de patients adultes ayant subi une rCOA, qui avaient été soumis à des épreuves d’effort cardiopulmonaire (EECP) et à un suivi entre 1994 et 2014 à la clinique Mayo. Les patients présentant une COA résiduelle (définie par une vitesse maximale du flux sur l’isthme aortique > 2,5 m/s) ont été exclus. La RHE était définie par une pression artérielle systolique maximale > 200 mm Hg; la définition des EIC comprenait les événements suivants : mortalité cardiovasculaire, AVC, syndrome coronarien aigu, hospitalisation pour insuffisance cardiaque et fraction d’éjection ventriculaire gauche (FEVG) < 35 %.


      Un total de 138 patients (82 hommes [59 %]) ont subi 213 EECP, et leur suivi a duré 85 ± 13 mois. L’âge des patients au moment de la réparation initiale de la COA était de 9 ± 3 ans; au moment des EECP initiaux, leur âge était de 40 ± 13 ans. La RHE est apparue chez 26 (19 %) patients; 24 (92 %) de ces patients étaient normotendus au repos. Aucune différence n'a été observée quant à l’âge, à la pression artérielle au repos et aux résultats des EECP entre les patients présentant une RHE et ceux dont la réponse hypertensive était normale à l’effort. Il s’est produit 28 EIC chez 24 patients (17 %), et la RHE était un facteur de risque indépendant d’EIC (rapport des risques instantanés [RRI]: 1,46 [1,13-2,52]; p = 0,04).


      La RHE peut apparaître même chez les sujets normotendus au repos, et constitue un facteur de risque d’EIC. Selon notre hypothèse, les patients obtenant une RHE représentent un groupe à risque élevé qui, vraisemblablement, sont atteints d’une dysfonction vasculaire avancée occulte. Les EECP pourraient permettre de reconnaître ces patients. L’avantage du traitement antihypertensif énergique reste à confirmer.
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