A clinical case of secondary hypertension in a young woman with coarctation of the aorta

The article presents a case of diagnosis and treatment of coarctation of the aorta in a 20-year-old woman, who previously received follow-up care with the diagnosis of hypertension. This case demonstrates the importance of qualitative examination of young patients with hypertension, including tonometry in the lower extremities and transthoracic echocardiography. The peculiarities of this clinical case encompass a rarer, isolated type of coarctation of the aorta and high physical fitness of the patient, which reduced doctors’ alertness regarding this anomaly. After surgical correction, a significant decrease in the blood pressure was achieved; however, such patients need longterm follow-up in order to detect complications, such as aneurysms, restenosis, or residual stenosis.

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Normative Arm and Calf Blood Pressure Values in the Newborn

PEDIATRICS ◽

10.1542/peds.83.2.240 ◽

1989 ◽

Vol 83 (2) ◽

pp. 240-243

Author(s):

Myung K. Park ◽

Da-Hae Lee

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mexican Americans ◽

Newborn Infants ◽

Coarctation Of The Aorta ◽

Upper Arm ◽

Mean Values ◽

The Right ◽

Diagnosis Of Hypertension ◽

Mean Heart Rate

Indirect BP measurement was obtained in the right upper arm in 219 healthy newborn infants with the Dinamap monitor and was compared with values obtained from the calf to establish normative BP values and to help establish a diagnosis of hypertension and coarctation of the aorta in the newborn. There were 174 Mexican-Americans (79.5%), 33 whites (15.0%), and 12 blacks (5.5%). The width of the BP cuff was selected to be 0.4 to 0.5 times the circumference of the extremities. Three supine position readings of BPs and heart rate were obtained from each site and were averaged for statistical analyses. Mean arm BP values (±SD) of the neonate less than 36 hours of age were 62.6±6.9/38.9± 5.7 mm Hg (48.0±6.2 mm Hg). Neonates older than 36 hours had slightly but significantly (P<.05) greater values (4 to 6 mm Hg) than did infants younger than 36 hours of age. Active neonates had values 6 to 10 mm Hg greater than quiet neonates (P<.05). BP values in the calf obtained with the same-sized cuff were almost identical with those obtained from the arm. Differences in consecutively obtained arm and calf BPs (arm values minus calf values) were 1.1±7.7 mm Hg systolic, -0.01 ± 6.2 mm Hg diastolic, and 0.9 ±6.9 mm Hg mean pressures. Mean heart rate (±SD) of neonates less than 36 hours of age was 129.4± 13.2 beats per minute and that of neonates older than 36 hours of age was 139.4± 14.1 beats per minute. These results show the following: (1) arm BPs and calf BPs using the same-sized cuff are almost identical with mean values of approximately 65/ 41 mm Hg (50 mm Hg) in neonates one to three days of age, (2) arm BP of 75/49 mm Hg (59 mm Hg) or greater is in the hypertensive range, and (3) calf BPs that are less than arm BPs by mean + 1 SD (6 to 9 mm Hg) necessitate a thorough investigation for coarctation of the aorta.

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Early Nephrectomy in Unilateral Multicystic Dysplastic Kidney in Children Cures Hypertension Early: An Observation

European Journal of Pediatric Surgery ◽

10.1055/s-0037-1599837 ◽

2017 ◽

Vol 27 (06) ◽

pp. 533-537 ◽

Cited By ~ 2

Author(s):

Vijai Upadhyaya ◽

Manish Gupta ◽

Laxmi Bharti ◽

Ram Rao ◽

Sheo Kumar ◽

...

Keyword(s):

Blood Pressure ◽

Antihypertensive Drugs ◽

Case Series ◽

Multicystic Dysplastic Kidney ◽

Time Duration ◽

Level Of Evidence ◽

Variable Time ◽

Dysplastic Kidney ◽

Diagnosis Of Hypertension

Objective Surgery is still indicated as the treatment of choice in subset of patients with unilateral multicystic dysplastic kidney (UMCDK) because of its potential complications and malignant change. The purpose of this study is to present our observation that early nephrectomy may cure hypertension early in children with UMCDK and review the literature. Materials and Methods We report here four children (two males and two females) with antenatally diagnosed UMCDK with hypertension, treated in the past 4 years. All have antenatal diagnosis of UMCDK and referred to us after their birth. Diagnosis of hypertension (blood pressure > 95th percentile) was made after 3 months of follow-up in all patients. Nephrectomy was performed in all children in variable time duration. Hypertension, urinary tract infection, and desire of parents were the main indication of surgery. Results All children showed decrease in the size of their dysplastic kidney with time, but hypertension was persistent and needed antihypertensive drugs; even increase in the doses in successive follow-up. After nephrectomy, three children who were operated early got cured having normal blood pressure within variable time duration, while a child, operated late, still had high blood pressure and needed antihypertensive drugs. Conclusion Early nephrectomy in recently diagnosed hypertension in UMCDK is advisable and can cure hypertension early. Levels of Evidence The level of evidence is IV (case series with no comparison group).

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Incidental Finding of an Undiagnosed Coarctation of the Aorta Causing Dilated Cardiomyopathy in an Adult

Case Reports in Cardiology ◽

10.1155/2017/6129073 ◽

2017 ◽

Vol 2017 ◽

pp. 1-2

Author(s):

Abdalla Ibrahim ◽

Zahir Satti ◽

Ronan Curtin

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Incidental Finding ◽

Coarctation Of The Aorta ◽

Left Ventricular ◽

Descending Aorta ◽

Arm Pain ◽

Left Ventricular Dilation ◽

History Of

31-year-old male with no past medical history apart from high blood pressure noted by GP one week prior to admission presented with a three-week history of a flu-like illness and symptoms of heart failure with severe global left ventricular dilation and dysfunction on Transthoracic Echocardiography (TTE). Two weeks following admission he complained of left arm pain and CT upper limb confirmed embolic occlusion of the left brachial artery and incidental severe coarctation of the proximal descending aorta after the origin of the left subclavian artery. Follow-up TTE suggested the presence of coarctation of the aorta on a suprasternal view which was not performed at the time of his first TTE. His heart failure and blood pressure responded very well to medical therapy and he has been referred for surgical correction of his aortic coarctation.

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Safety and efficacy of stenting for aortic arch hypoplasia in patients with coarctation of the aorta

Netherlands Heart Journal ◽

10.1007/s12471-019-01353-5 ◽

2019 ◽

Vol 28 (3) ◽

pp. 145-152

Author(s):

E. G. Warmerdam ◽

G. J. Krings ◽

T. A. Meijs ◽

A. C. Franken ◽

B. W. Driesen ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Aortic Arch ◽

Retrospective Analysis ◽

Medical Center ◽

Systolic Pressure ◽

Coarctation Of The Aorta ◽

Safety And Efficacy ◽

Aortic Arch Hypoplasia

Abstract Background Despite a successful repair procedure for coarctation of the aorta (CoA), up to two-thirds of patients remain hypertensive. CoA is often seen in combination with abnormal aortic arch anatomy and morphology. This might be a substrate for persistent hypertension. Therefore, we performed endovascular aortic arch stent placement in patients with CoA and concomitant aortic arch hypoplasia or gothic arch morphology. The goal of this retrospective analysis was to investigate the safety and efficacy of aortic arch stenting. Methods A retrospective analysis was performed in patients who underwent stenting of the aortic arch at the University Medical Center Utrecht. Measurements collected included office blood pressure, use of antihypertensive medication, invasive peak-to-peak systolic pressure over the arch, and aortic diameters on three-dimensional angiography. Data on follow-up were obtained at the date of most recent outpatient visit. Results Twelve patients underwent stenting of the aortic arch. Mean follow-up duration was 14 ± 11 months. Mean peak-to-peak gradient across the arch decreased from 39 ± 13 mm Hg to 7 ± 8 mm Hg directly after stenting (p < 0.001). There were no major procedural complications. Mean systolic blood pressure decreased from 145 ± 16 mm Hg at baseline to 128 ± 9 mm Hg at latest follow-up (p = 0.014). Conclusion This retrospective study shows that stenting of the aortic arch is successful when carried out in a state-of-the-art manner. A direct optimal angiographic and haemodynamic result was shown. No major complications occurred during or after the procedure. At short- to medium-term follow-up a decrease in mean systolic blood pressure was observed.

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Transthoracic Echocardiography to Assess Aortic Regurgitation after TAVR: A Comparison with Periprocedural Transesophageal Echocardiography

Cardiology ◽

10.1159/000452617 ◽

2016 ◽

Vol 137 (1) ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Alexandra Goncalves ◽

Charles Nyman ◽

David R. Okada ◽

Avinainder Singh ◽

Jeffrey Swanson ◽

...

Keyword(s):

Blood Pressure ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Transesophageal Echocardiography ◽

Aortic Regurgitation ◽

Transthoracic Echocardiography ◽

Transcatheter Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Overall Mortality

Background: We aimed to compare periprocedural transesophageal echocardiography (TEE) with postprocedural transthoracic echocardiography (TTE) for the diagnosis of aortic regurgitation (AR). Methods and Results: TEE and TTE images of 163 transcatheter aortic valve replacement (TAVR) patients (mean age 81 ± 8 years; 56% men) were reviewed separately and blinded to each other as well as to all clinical data. The median time between TEE during TAVR (TEE/TAVR) and TTE was 4 days (IQR 2-10 days). After TAVR, 48% of the patients had at least trace AR by TEE, 56% by angiography and 67% by TTE. The majority of AR was paravalvular (78%). More patients were classified with mild-to-moderate AR by TTE than by TEE (44 vs. 22%, p < 0.01). When examining the 46 patients with AR by TTE which was not at TEE/TAVR, both systolic and diastolic blood pressure (SBP and DBP) were significantly higher during TTE than during TEE (mean ΔSBP = 9 ± 4 mm Hg and mean ΔDBP = 6 ± 2 mm Hg, p < 0.01 for both). No differences in BP between TEE and TTE were found among patients with no AR or among those who had AR in both studies. At a median follow-up of 185 days (IQR 39-424 days), the overall mortality was 17%, but this was not associated with the presence of AR on TTE or TEE. Conclusions: Patients' hemodynamic conditions may result in underdiagnosis of paravalvular regurgitation in periprocedural TEE. Our findings suggest that a postprocedural evaluation for AR by TTE could serve as a reasonable alternative to TEE for the evaluation of AR.

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Effect of smoking cessation with varenicline on blood pressure control in hypertensive patients

European Heart Journal ◽

10.1093/ehjci/ehaa946.3019 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Ioakeimidis ◽

C Georgakopoulos ◽

E Emmanouil ◽

I Dima ◽

E Solomou ◽

...

Keyword(s):

Blood Pressure ◽

Smoking Cessation ◽

Cigarette Smoking ◽

Arterial Hypertension ◽

Nicotine Dependence ◽

Self Report ◽

Time Interval ◽

Smoking Abstinence ◽

Diagnosis Of Hypertension

Abstract Purpose The interaction between smoking and blood pressure (BP) is complex. Despite the strong association between cigarette smoking and cardiovascular disease (CVD) risk, there is paucity about the effect of pharmacotherapies for treating tobacco dependence on BP in already established arterial hypertension. Varenicline has been shown to be an effective and well-tolerated pharmaceutical intervention for smoking cessation. Aim of the study was to investigate the improvement in BP control in smokers with a diagnosis of hypertension who quit or reduced substantially their tobacco consumption by using varenicline and the association of nicotine dependence with BP changes. Methods A total of 89 (mean age:48±7, 52 males) regular smokers (28±9 pack-years) with a diagnosis of hypertension and on anti-hypertensive drugs were studied. All patients received low-intensity counseling and pharmacotherapy with varenicline (1 mg twice daily) for 12 weeks. Point prevalence smoking abstinence was defined by self-report of complete abstinence in the 7 days before the 12 week clinic visit (end of therapy). Office BP was measured at baseline and each follow-up visit (4 and 12 weeks) office BP. The Fagerström Test for Nicotine Dependence (FTND) was used for assessing nicotine dependence. High nicotine dependence (ND) was defined as a FTND score ≥6. Results At 12 weeks, 60 (67%) patients were abstinent from smoking and 14 (16%) were non-abstainers who reduced daily consumption to 50% of baseline. The mean time interval between the initiation of treatment with varenicline and smoking abstinence was 1.8±0.6 weeks. There were not significant differences in age, baseline BP level, severity of nicotine dependence and total cigarette consumption (pack-years) between the two groups. Systolic BP (SBP) and diastolic BP (DBP) decreased significantly in abstainers (by 7.2 and 5.5 mmHg at 12 weeks, P<0.01 and P<0.05, respectively) while the decrease in BP level in non-abstainers was minimal. Among patients with sustained tobacco abstinence, 18 were highly ND and 42 had mild and moderate ND. The two ND groups had similar age and BP levels at baseline. Changes in SBP and DBP from baseline in smokers with arterial hypertension between the two ND groups are illustrated in Figure. The observed reductions in SBP and DBP were significant (P<0.05, both for SBP and DBP) when comparing the high ND group to the mild/moderate ND group at 12 weeks. No severe adverse reactions were reported with varenicline use throughout the entire follow-up duration. Conclusion Varenicline may help smokers with arterial hypertension under antihypertensive therapy to remain abstinent from tobacco cigarette smoking. A novel and important message of this study is also the substantial improvements in office SBP and DBP in highly nicotine dependent sustained tobacco abstainers. ND-BP changes after varenicline therapy Funding Acknowledgement Type of funding source: None

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Implantation of Covered Stent for Coarctation of the Aorta and Secondary Hypertension in Adolescents—Case Report

Children ◽

10.3390/children8111018 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1018

Author(s):

Simina-Elena Ghiragosian-Rusu ◽

Cristina Blesneac ◽

Anca Sglimbea ◽

Claudiu Ghiragosian ◽

Laszlo Hadadi ◽

...

Keyword(s):

Blood Pressure ◽

Case Report ◽

Arterial Hypertension ◽

Coarctation Of The Aorta ◽

Holter Monitoring ◽

Secondary Hypertension ◽

Covered Stent ◽

Lower Limbs ◽

Interventional Treatment ◽

High Morbidity

Introduction: Coarctation of the aorta represents a narrowing of the thoracic aorta. Hypertensive patients with blood pressure differences ≥20 millimetres of mercury have an indication for surgical or interventional treatment. Implantation of a covered stent became the preferred therapy for the management of this pathology in adolescents/adults. Case report: We report the case of a 14-year-old male sportsman, who presented in the emergency room with headache, dizziness, and tinnitus. The clinical exam revealed blood pressure differences between the upper and lower limbs of up to 50 mmHg. Based on the clinical and paraclinical data, we established the diagnosis of coarctation of the aorta and severe secondary arterial hypertension. The case was discussed by a multidisciplinary team and accepted for covered stent implantation. The 24 h blood pressure Holter monitoring after the procedure indicated the persistence of stage I arterial hypertension. Conclusions: Coarctation of the aorta is a congenital cardiovascular anomaly with high morbidity and mortality rates. Arterial hypertension, heart failure, and aortic dissection are complications of this pathology, some of them being sometimes direct consequences of secondary hypertension. Periodic cardiology follow up after the procedure is mandatory to assess the hemodynamic response, to identify potential complications, and to stratify the cardiovascular risk.

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Abstract 194: Spontaneous Spinal Subarachnoid Hemorrhage: A Mayo Clinic Case Series

Stroke ◽

10.1161/str.48.suppl_1.194 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Micah D Yost ◽

Alejandro A Rabinstein

Keyword(s):

Blood Pressure ◽

Subarachnoid Hemorrhage ◽

Mayo Clinic ◽

Case Series ◽

Coarctation Of The Aorta ◽

Pressure Control ◽

Cord Compression ◽

Chronic Hypertension ◽

Spinal Subarachnoid Hemorrhage

Background: Spontaneous spinal subarachnoid hemorrhage (SSAH) is a rare but serious condition that can lead to a variety of medical complications. Methods: Using the Mayo Clinic Rochester database, patients admitted to the Mayo Clinic Rochester, MN hospital with spontaneous SSAH (not iatrogenic or traumatic) between January 2000 and December 2015 were retrospectively reviewed. Demographic and clinical data and functional outcomes as described by the modified Rankin Scale (mRS) score at the time of discharge and at post-admission follow-up were assessed. Results: Eight consecutive patients (median age 70 years, range 51-87) were identified. Seven patients presented with acute onset back pain or headache. Seven patients had poorly controlled chronic hypertension. Two patients had vasculitis, and one had an arteriovenous malformation (AVM). An increase in blood pressure was observed in all patients during their acute presentation as compared to their baseline outpatient readings. Complications included cord compression (n = 4), hyponatremia (n = 5), sulcal subarachnoid hemorrhage (n = 2), chronic arachnoiditis (n=1), vasospasm (n=1), and late cord ischemia (n = 1). All eight patients were managed medically including blood pressure control and repeat imaging. One patient had an aneurysm which was embolized, and two received steroids for vasculitis. One patient died during hospitalization, one died within a week of discharge, five had improved mRS score at post-hospitalization follow-up and had unchanged mRS of 1 at discharge and follow-up. Conclusions: To our knowledge this is the first compilation of cases of spontaneous SSAH. Risk factors for spontaneous SSAH are hypertension, AVM, vasculitis, coarctation of the aorta, and malignancy. Symptomatic cord compression is not uncommon, but can be managed conservatively.

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Medium-term systemic blood pressure after stenting of aortic coarctation: a systematic review and meta-analysis

Heart ◽

10.1136/heartjnl-2019-314965 ◽

2019 ◽

Vol 105 (19) ◽

pp. 1464-1470 ◽

Cited By ~ 3

Author(s):

Timion A Meijs ◽

Evangeline G Warmerdam ◽

Martijn G Slieker ◽

Gregor J Krings ◽

Mirella M C Molenschot ◽

...

Keyword(s):

Blood Pressure ◽

Stent Implantation ◽

Meta Analysis ◽

Coarctation Of The Aorta ◽

Final Analysis ◽

Systemic Blood Pressure ◽

Cardiovascular Complications ◽

Medium Term ◽

Systemic Blood

ObjectiveLong-term prognosis of patients with coarctation of the aorta (CoA) is impaired due to the high prevalence of hypertension and consequent cardiovascular complications. Although stent implantation results in acute anatomical and haemodynamic benefit, limited evidence exists regarding the late clinical outcome. In this meta-analysis, we aimed to evaluate the medium-term effect of stent placement for CoA on systemic blood pressure (BP).MethodsPubMed, EMBASE and Cochrane databases were searched for non-randomised cohort studies addressing systemic BP ≥12 months following CoA stenting. Meta-analysis was performed on the change in BP from baseline to last follow-up using a random-effects model. Subgroup analyses and meta-regression were conducted to identify sources of heterogeneity between studies.ResultsTwenty-six studies with a total of 1157 patients and a median follow-up of 26 months were included for final analysis. Meta-analysis showed a 20.3 mm Hg (95% CI 16.4 to 24.1 mm Hg; p<0.00001) reduction in systolic BP and an 8.2 mm Hg (12 studies; 95% CI 5.2 to 11.3 mm Hg; p<0.00001) reduction in diastolic BP. A concomitant decrease in the use of antihypertensive medication was observed. High systolic BP and peak systolic gradient at baseline and stenting of native CoA were associated with a greater reduction in systolic BP at follow-up.ConclusionsStent implantation for CoA is associated with a significant decline in systolic and diastolic BP during medium-term follow-up. The degree of BP reduction appears to be dependent on baseline systolic BP, baseline peak systolic gradient, and whether stenting is performed for native or recurrent CoA.

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Recent management of surgically correctable hypertension

QJM ◽

10.1093/qjmed/hcab097.022 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Emad EL-Din Farid Ibrahim ◽

Shaaban Mohammed Abd-Elmgeed ◽

Fawzy Salah Fawzy Eweda ◽

Gerges Hosney Loka Felebs

Keyword(s):

Renal Artery ◽

Data Extraction ◽

Young Patients ◽

Life Quality ◽

Coarctation Of The Aorta ◽

Secondary Hypertension ◽

Eligibility Criteria ◽

Obstructive Sleep ◽

Ethical Approval ◽

Parenchymal Disease

Abstract Background Surgical hypertension is elevated blood pressure that results from an underlying, identifiable, often correctable cause. Obstructive sleep Apnea, Aldosteronism, presence of renal artery Bruits (suggesting renal artery stenosis), renal parenchymal disease (Bad kidneys), excess Catecholamines, Coarctation of the aorta, Cushing's syndrome, Drugs, Diet, polycythemia, and some neuroendocrine tumors. Objective To assess, through the available literature. The role of surgery in the management of endocrine, renal and vascular causes of hypertension and outcome benefits of surgery. Data Sources Medline databases (PubMed, Medscape, Science Direct. EMF-Portal) and all materials available in the Internet till 2018. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion Secondary hypertension may be due to underlying correctable cause. Diagnosis and surgical correction of the underlying cause may improve hypertension and improve life quality of the patient especially in young patients resistant to medical therapy for hypertension.

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