Exercise-induced hypertension in the arms due to impaired arterial reactivity after successful coarctation resection
Exercise-induced hypertension of the arms is a wellknown late complication after coarctation repair. Residual narrowing at the anastomosis site as well as abnormalities of the precoarctation arterial system may be the cause of this problem. Blood pressure response to exercise and flow-mediated arter...
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| Veröffentlicht in: | The American journal of cardiology 1995-04, Vol.75 (12), p.814-817 |
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| description | Exercise-induced hypertension of the arms is a wellknown late complication after coarctation repair. Residual narrowing at the anastomosis site as well as abnormalities of the precoarctation arterial system may be the cause of this problem. Blood pressure response to exercise and flow-mediated arterial dilatation of the arms and legs were studied in 29 young adults after successful coarctectomy in childhood and compared with 13 control subjects. Peak exercise systolic blood pressure was significantly higher in patients than in control subjects: 238 versus 199 mm Hg (p = 0.007). Both groups had a positive systolic arm-leg gradient during exercise: 59 versus 37 mm Hg (p = 0.05). Flow-mediated dilatation of the brachial artery was significantly reduced in patients compared with that in control subjects: 4.2% (range 0% to 9.4%) versus 9.4% (range 3.7% to 16%) (p < 0.0001). Flow-mediated dilatation of the femoral artery was similar in both groups. Dilatation of the brachial artery was inversely correlated to peak exercise systolic pressure in the study patients (r = −0.427, p = 0.02). A positive arm-leg exercise gradient partly represents physiologic circulatory adaptation to ergometry and is therefore not appropriate for evaluation of residual narrowing. Exercise-induced hypertension of the arms late after coarctation repair is caused by impaired arterial reactivity, which results from structural or functional abnormality, or both. |
| doi_str_mv | 10.1016/S0002-9149(99)80418-4 |
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Residual narrowing at the anastomosis site as well as abnormalities of the precoarctation arterial system may be the cause of this problem. Blood pressure response to exercise and flow-mediated arterial dilatation of the arms and legs were studied in 29 young adults after successful coarctectomy in childhood and compared with 13 control subjects. Peak exercise systolic blood pressure was significantly higher in patients than in control subjects: 238 versus 199 mm Hg (p = 0.007). Both groups had a positive systolic arm-leg gradient during exercise: 59 versus 37 mm Hg (p = 0.05). Flow-mediated dilatation of the brachial artery was significantly reduced in patients compared with that in control subjects: 4.2% (range 0% to 9.4%) versus 9.4% (range 3.7% to 16%) (p < 0.0001). Flow-mediated dilatation of the femoral artery was similar in both groups. Dilatation of the brachial artery was inversely correlated to peak exercise systolic pressure in the study patients (r = −0.427, p = 0.02). A positive arm-leg exercise gradient partly represents physiologic circulatory adaptation to ergometry and is therefore not appropriate for evaluation of residual narrowing. Exercise-induced hypertension of the arms late after coarctation repair is caused by impaired arterial reactivity, which results from structural or functional abnormality, or both.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/S0002-9149(99)80418-4</identifier><identifier>PMID: 7717286</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Anastomosis, Surgical - adverse effects ; Aortic Coarctation - physiopathology ; Aortic Coarctation - surgery ; Arm - blood supply ; Arms ; Biological and medical sciences ; Blood Pressure - physiology ; Brachial Artery - physiopathology ; Case-Control Studies ; Constriction, Pathologic - etiology ; Ergometry ; Exercise ; Exercise Test ; Femoral Artery - physiopathology ; Humans ; Hyperemia - physiopathology ; Hypertension ; Hypertension - etiology ; Hypertension - physiopathology ; Leg - blood supply ; Legs ; Medical research ; Medical sciences ; Physical Exertion - physiology ; Regional Blood Flow - physiology ; Surgery ; Surgery (general aspects). 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Residual narrowing at the anastomosis site as well as abnormalities of the precoarctation arterial system may be the cause of this problem. Blood pressure response to exercise and flow-mediated arterial dilatation of the arms and legs were studied in 29 young adults after successful coarctectomy in childhood and compared with 13 control subjects. Peak exercise systolic blood pressure was significantly higher in patients than in control subjects: 238 versus 199 mm Hg (p = 0.007). Both groups had a positive systolic arm-leg gradient during exercise: 59 versus 37 mm Hg (p = 0.05). Flow-mediated dilatation of the brachial artery was significantly reduced in patients compared with that in control subjects: 4.2% (range 0% to 9.4%) versus 9.4% (range 3.7% to 16%) (p < 0.0001). Flow-mediated dilatation of the femoral artery was similar in both groups. Dilatation of the brachial artery was inversely correlated to peak exercise systolic pressure in the study patients (r = −0.427, p = 0.02). A positive arm-leg exercise gradient partly represents physiologic circulatory adaptation to ergometry and is therefore not appropriate for evaluation of residual narrowing. Exercise-induced hypertension of the arms late after coarctation repair is caused by impaired arterial reactivity, which results from structural or functional abnormality, or both.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anastomosis, Surgical - adverse effects</subject><subject>Aortic Coarctation - physiopathology</subject><subject>Aortic Coarctation - surgery</subject><subject>Arm - blood supply</subject><subject>Arms</subject><subject>Biological and medical sciences</subject><subject>Blood Pressure - physiology</subject><subject>Brachial Artery - physiopathology</subject><subject>Case-Control Studies</subject><subject>Constriction, Pathologic - etiology</subject><subject>Ergometry</subject><subject>Exercise</subject><subject>Exercise Test</subject><subject>Femoral Artery - physiopathology</subject><subject>Humans</subject><subject>Hyperemia - physiopathology</subject><subject>Hypertension</subject><subject>Hypertension - etiology</subject><subject>Hypertension - physiopathology</subject><subject>Leg - blood supply</subject><subject>Legs</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Physical Exertion - physiology</subject><subject>Regional Blood Flow - physiology</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Systole</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><subject>Vasodilation - physiology</subject><subject>Vasomotor System - physiopathology</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkcFu1DAQhi0EKtvCI1SyEEJwCHicOI5PFapaQKrEAThbE2esusomi-1U7NvjdFd74MLJY_vz79F8jF2C-AgC2k8_hBCyMtCY98Z86EQDXdU8YxvotKnAQP2cbU7IS3ae0kPZAqj2jJ1pDVp27Yblmz8UXUhUhWlYHA38fr-jmGlKYZ54mHi-J45xm_iwEM8zD9sdhlhALFQMOPJI6HJ4DHnP0ZcznhbnKCW_jNzNGF3GvIZFSuTW6hV74XFM9Pq4XrBftzc_r79Wd9-_fLv-fFc5BZArCag651tphJS6bRQ2dal9J4B6PbTek-kHIEl9J5VH3TiNQz9oTRqVgvqCvTvk7uL8e6GU7TYkR-OIE81LslrLEtw0BXzzD_gwL3EqvVlZi7qVqpUFUgfIxTmlSN7uYthi3FsQdlVin5TYdd7WGPukxK7hl8fwpd_ScHp1dFDu3x7vMTkcfcSpCDlhtTKthvX7qwNGZWKPgaJNLtBUlBUbLtthDv9p5C_TWaoA</recordid><startdate>19950415</startdate><enddate>19950415</enddate><creator>Guenthard, Joëlle</creator><creator>Wyler, Felix</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>19950415</creationdate><title>Exercise-induced hypertension in the arms due to impaired arterial reactivity after successful coarctation resection</title><author>Guenthard, Joëlle ; Wyler, Felix</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-21a58cf6290227645a43290f801eb7d6ffe9bd1e2eb825fa74c7adbd77e7a5513</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anastomosis, Surgical - adverse effects</topic><topic>Aortic Coarctation - physiopathology</topic><topic>Aortic Coarctation - surgery</topic><topic>Arm - blood supply</topic><topic>Arms</topic><topic>Biological and medical sciences</topic><topic>Blood Pressure - physiology</topic><topic>Brachial Artery - physiopathology</topic><topic>Case-Control Studies</topic><topic>Constriction, Pathologic - etiology</topic><topic>Ergometry</topic><topic>Exercise</topic><topic>Exercise Test</topic><topic>Femoral Artery - physiopathology</topic><topic>Humans</topic><topic>Hyperemia - physiopathology</topic><topic>Hypertension</topic><topic>Hypertension - etiology</topic><topic>Hypertension - physiopathology</topic><topic>Leg - blood supply</topic><topic>Legs</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Physical Exertion - physiology</topic><topic>Regional Blood Flow - physiology</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Systole</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><topic>Vasodilation - physiology</topic><topic>Vasomotor System - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Guenthard, Joëlle</creatorcontrib><creatorcontrib>Wyler, Felix</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Guenthard, Joëlle</au><au>Wyler, Felix</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Exercise-induced hypertension in the arms due to impaired arterial reactivity after successful coarctation resection</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>1995-04-15</date><risdate>1995</risdate><volume>75</volume><issue>12</issue><spage>814</spage><epage>817</epage><pages>814-817</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Exercise-induced hypertension of the arms is a wellknown late complication after coarctation repair. Residual narrowing at the anastomosis site as well as abnormalities of the precoarctation arterial system may be the cause of this problem. Blood pressure response to exercise and flow-mediated arterial dilatation of the arms and legs were studied in 29 young adults after successful coarctectomy in childhood and compared with 13 control subjects. Peak exercise systolic blood pressure was significantly higher in patients than in control subjects: 238 versus 199 mm Hg (p = 0.007). Both groups had a positive systolic arm-leg gradient during exercise: 59 versus 37 mm Hg (p = 0.05). Flow-mediated dilatation of the brachial artery was significantly reduced in patients compared with that in control subjects: 4.2% (range 0% to 9.4%) versus 9.4% (range 3.7% to 16%) (p < 0.0001). Flow-mediated dilatation of the femoral artery was similar in both groups. Dilatation of the brachial artery was inversely correlated to peak exercise systolic pressure in the study patients (r = −0.427, p = 0.02). A positive arm-leg exercise gradient partly represents physiologic circulatory adaptation to ergometry and is therefore not appropriate for evaluation of residual narrowing. Exercise-induced hypertension of the arms late after coarctation repair is caused by impaired arterial reactivity, which results from structural or functional abnormality, or both.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>7717286</pmid><doi>10.1016/S0002-9149(99)80418-4</doi><tpages>4</tpages></addata></record> |
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| issn | 0002-9149 1879-1913 |
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| subjects | Adolescent Adult Anastomosis, Surgical - adverse effects Aortic Coarctation - physiopathology Aortic Coarctation - surgery Arm - blood supply Arms Biological and medical sciences Blood Pressure - physiology Brachial Artery - physiopathology Case-Control Studies Constriction, Pathologic - etiology Ergometry Exercise Exercise Test Femoral Artery - physiopathology Humans Hyperemia - physiopathology Hypertension Hypertension - etiology Hypertension - physiopathology Leg - blood supply Legs Medical research Medical sciences Physical Exertion - physiology Regional Blood Flow - physiology Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Systole Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels Vasodilation - physiology Vasomotor System - physiopathology |
| title | Exercise-induced hypertension in the arms due to impaired arterial reactivity after successful coarctation resection |
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