Elevated sympathetic activity, endothelial dysfunction, and late hypertension after repair of coarctation of the aorta

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Elevated sympathetic activity, endothelial dysfunction, and late hypertension after repair of coarctation of the aorta

author Lee, MGY
author Hemmes, RA
author Mynard, J
author Lambert, E
author Head, GA
author Cheung, MMH
author Konstantinov, IE
author Brizard, CP
author Lambert, G
author d'Udekem, Y
Year 2017
citation Int J Cardiol 2017;243:85-190
issn 0167-5273
URI http://hdl.handle.net/11187/2897
abstract BACKGROUND: There is a high prevalence of late hypertension after coarctation repair. The relative contribution of elevated sympathetic tone and endothelial dysfunction to its development is unknown. This study aims to investigate the neural profile of coarctation patients including muscle sympathetic nerve activity testing to directly measure sympathetic nervous activity. METHODS: Twenty-three patients aged ≥18years with a coarctation repair underwent measurements of clinic and 24-h blood pressures, muscle sympathetic nerve activity, sympathetic and cardiac baroreflex functions, digital endothelial function, and ambulatory arterial stiffness index. Median age at repair was 1.2months (interquartile range: 0-9months). Patients were compared to 17 healthy matched controls. RESULTS: After 26±5years, 6% (1/18) and 44% (8/18) suffered clinic hypertension and prehypertension, respectively. On 24-h blood pressure monitoring, 15% (3/20) and 20% (4/20) had hypertension and prehypertension, respectively. Coarctation patients had elevated muscle sympathetic nerve activity compared with controls (49.6±24.9 vs. 29.9±14.0 bursts/100 heartbeats, p=0.02), dampened sympathetic baroreflex function (-2.2±2.1 vs. -7.0±5.6 bursts/100heartbeats·mm·Hg-1, p=0.007), normal cardiac baroreflex function (41.9±30.4 vs. 35.7±21.1ms·mm·Hg-1, p=0.6), endothelial dysfunction (pulse amplitude tonometry ratio: 0.39±0.32 vs. 0.81±0.50, p=0.004), and increased ambulatory arterial stiffness index (0.46±0.15 vs. 0.29±0.17, p=0.008). CONCLUSION: After coarctation repair patients have increased muscle sympathetic nerve activity, dampened sympathetic baroreflex response, endothelial dysfunction, and increased ambulatory arterial stiffness index, all of which may contribute to the development of late hypertension. Copyright © 2017 Elsevier B.V. All rights reserved.
sponsorship NHMRC: 1134274, 1082186, 1042492, 1002186; NHF: 100681
publisher Elsevier
title Elevated sympathetic activity, endothelial dysfunction, and late hypertension after repair of coarctation of the aorta
type Journal Article
doi 10.1016/j.ijcard.2017.05.075


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