Systolic Hypertension During Submaximal Exercise After Correction of Coarctation of Aorta

Fourteen patients who were 9 to 22 years of age and had surgical repair of coarctation of the thoracic aorta during childhood were subjected to strenuous upright exercise. Nine patients had satisfactory surgical repair by physical examination, four patients had residual gradients of 50, 34, 20, and 18 mm Hg across the surgical anastomosis, and one patient had mild to moderate aortic insufficiency. Prior to surgery all patients were hypertensive at rest. During postoperative follow-up 11 patients had resting supine systolic and/or diastolic pressures in the 90 to 95th percentile or greater, and three patients had normal blood pressures.

During exercise nine patients developed systolic pressures between 212 and 270 mm Hg. The diastolic pressures increased to 100 mm Hg in one patient but tended to decrease or remain unchanged in the others. Five patients had a normal blood pressure response and stress electrocardiogram. Significant ST segmental depression occurred in two patients with residual gradients of 50 and 34 mm Hg across the surgical anastomosis. In the control group the peak systolic pressures during exercise were between 92 and 190 mm Hg. The diastolic pressures increased slightly.

This study suggested that surgical repair of coarctation of the thoracic aorta may not cure pre-existing hypertension and that significant elevation of blood pressure may occur at rest and during exercise in this young active population.