Paradoxical increase in ambulatory SBP in coarctation of aorta a compared to essential hypertension

Alexander C. Egbe; William R. Miranda; Likhita Shaik; Renuka Reddy Katta; Ahmed Goda Sakr; Janaki Devara; Heidi M. Connolly

doi:10.1097/MBP.0000000000000573

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Paradoxical increase in ambulatory SBP in coarctation of aorta a compared to essential hypertension

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Paradoxical increase in ambulatory SBP in coarctation of aorta a compared to essential hypertension

Alexander C. Egbe, William R. Miranda, Likhita Shaik, Renuka Reddy Katta, Ahmed Goda Sakr, Janaki Devara and Heidi M. Connolly

Blood pressure monitoring, Vol.27(2), pp.98-104

04/01/2022

DOI: 10.1097/MBP.0000000000000573

PMCID: PMC8897210

PMID: 34855652

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https://www.ncbi.nlm.nih.gov/pmc/articles/8897210View

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Abstract

Background The relationship between office vs. ambulatory blood pressure (BP) indices are well-studied in patients with essential hypertension and based on these data, it is known that the average 24-h ambulatory BP is typically lower than office BP. However, emerging data show that office SBP underestimates arterial afterload in patients with coarctation of aorta (COA), and a minimal increase in stroke volume during low-intensity exercise results in an exaggerated rise in SBP as compared to those with essential hypertension. We hypothesized that COA patients will have higher ambulatory SBP and a higher prevalence of masked hypertension compared to patients with essential hypertension. Methods Case-control study of 118 COA patients and 118 patients with essential hypertension matched by age, sex, BMI and office SBP. Results Although both groups had similar office SBP (132 +/- 17 mmHg) by design, the COA group had paradoxical increases in 24-h ambulatory SBP (135 +/- 14 vs. 126 +/- 13; P < 0.001) and daytime ambulatory SBP (142 +/- 16 vs. 130 +/- 13; P < 0.001), and less nocturnal dipping (-3 +/- 5 vs. -9 +/- 4; P < 0.001). The COA group also had a higher prevalence of masked hypertension [36 (31%) vs 14 (12%); P < 0.001), and worse arterial function indices. Conclusion These findings underscore the potential limitations of relying on office SBP for screening/monitoring of hypertension in COA and potential pitfalls in extrapolating essential hypertension guidelines recommendations to the treatment of COA. It also provides the rationale for further studies to determine if pharmacologic BP interventions guided by ambulatory BP data will improve clinical outcomes in the COA population.

Cardiovascular System & Cardiology

Life Sciences & Biomedicine

Peripheral Vascular Disease

Science & Technology

Details

Title: Subtitle: Paradoxical increase in ambulatory SBP in coarctation of aorta a compared to essential hypertension
Creators: Alexander C. Egbe - Mayo Clinic
William R. Miranda - Mayo Clinic
Likhita Shaik - Mayo Clinic
Renuka Reddy Katta - Mayo Clinic
Ahmed Goda Sakr - Mayo Clinic
Janaki Devara - Mayo Clinic
Heidi M. Connolly - Mayo Clinic
Resource Type: Journal article
Publication Details: Blood pressure monitoring, Vol.27(2), pp.98-104
DOI: 10.1097/MBP.0000000000000573
PMID: 34855652
PMCID: PMC8897210
NLM abbreviation: Blood Press Monit
ISSN: 1359-5237
eISSN: 1473-5725
Publisher: Lippincott Williams & Wilkins
Number of pages: 7
Grant note: K23 HL141448 / National Heart, Lung, and Blood Institute (NHLBI); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) K23HL141448 / National Heart Lung and Blood Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
Language: English
Date published: 04/01/2022
Academic Unit: Neurology
Record Identifier: 9985143124602771

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