Congenital heart disease
Altered baroreceptor function in children with systolic hypertension after coarctation repair

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Abstract

To determine whether altered baroreceptor function may contribute to systemic hypertension after coarctation of the aorta (C of A) repair, baroreceptor function was evaluated in 6 children with repaired C of A mild arm systolic hypertension. Data were compared with those from 7 normotensive control children with hemodynamically mild heart disease. Age at C of A repair averaged 9.9 ± 3.1 years (mean ± standard deviation [SD]). Arm systolic pressure was 143.8 ± 2.9 mm Hg in the C of A repair group, compared with 118.3 ± 9.9 for control subjects (p < 0.001). At catheterization, steady-state sigmoidal baroreceptor function curves relating mean arterial pressure to R-R interval were derived by increasing and decreasing mean arterial pressure with small injections of phenylephrine and nitroprusside. Compared with control subjects, the baroreceptor function curves of children with repaired C of A (1) are reset about a higher baseline mean arterial pressure (108.8 ± 6.6 versus 90.3 ± 8.6 mm Hg, p < 0.01), (2) have a decreased slope (7.9 ± 3.7 versus 17.4 ± 3.6 ms/mm Hg, p < 0.001), and (3) have a diminished R-R interval range (246.7 ± 81.5 versus 535.7 ± 97.2 ms, p < 0.001). Thus, in children with hypertension after C of A repair, the baroreflex is reset to an elevated mean arterial pressure level and has a diminished sensitivity to changes in arterial pressure.

References (30)

  • MD Freed et al.

    Exercise-induced hypertension after surgical repair of coarctation of the aorta

    Am J Cardiol

    (1979)
  • RH Beekman et al.

    Reoperation for coarctation of the aorta

    Am J Cardiol

    (1981)
  • P Sleight

    Reflex control of the heart

    Am J Cardiol

    (1979)
  • BJ Maron et al.

    Prognosis of surgically corrected coarctatlon of the aorta. A 20 year postoperative appraisal

    Circulation

    (1973)
  • AB Simon et al.

    Coarctation of the aorta. Longitudinal assessment of operated patients

    Circulation

    (1974)
  • FW James et al.

    Systolic hypertension during submaximal exercise after correction of coarctation of the aorta

    Circulation

    (1974)
  • TM Connor

    Evaluation of persistent coarctation of the aorta after surgery with blood pressure measurement and exercise testing

    Am J Cardiol

    (1969)
  • LI Bonchek et al.

    Baroreflex sensitivity and carotid sinus dimensions in dogs with coarctation

    J Appl Physiol

    (1976)
  • FO Igler et al.

    Coarctation of the aorta and baroreceptor resetting. A study of carotid baroreceptor stimulus-response characteristics before and after surgical repair in the dog

    Circ Res

    (1981)
  • JD Bristow et al.

    Diminished baroreflex sensitivity in high blood pressure

    Circulation

    (1969)
  • B Gribbin et al.

    Effect of age and high blood pressure on baroreflex sensitivity in man

    Circ Res

    (1971)
  • PI Korner et al.

    “Steady-state” properties of the baroreceptor-heart rate reflex in essential hypertension in man

    Clin Exp Pharm Physiol

    (1974)
  • AE Doan et al.

    Myocardial ischemia after maximal exercise in healthy men

    Am Heart J

    (1965)
  • National Heart, Lung, and Blood Institute's Task Force on Blood Pressure Control in Children

    Report of the task force on blood pressure control in children

    Pediatrics

    (1977)
  • GB Guo et al.

    Differential baroreflex control of heart rate and vascular resistance in rabbits

    Circ Res

    (1982)
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    This study was supported in part by National Institutes of Health Grant MO 1 RR00042-21, Clinical Research Center, University Hospitals, Ann Arbor, Michigan.

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