Egbe AC, Miranda WR, Jain CC, Connolly HM.
Am Heart J. 2023 Jan;255:22-30. doi: 10.1016/j.ahj.2022.10.008. Epub 2022 Oct 8.
PMID: 36220358
Take-Home Points:
- A sBP > 120mmHg was associated with cardiovascular mortality, with a 7% increase in the risk of cardiovascular mortality for every 5mmHg increase in sBP.
- So even lesser degrees of BP elevation is not benign.
- There was an association of increased cardiovascular mortality in patient with dBP >90mmHg (not across all elevated dBP strata)
- Most adverse events were mild, and due to electrolyte abnormalities.
- The incidence of adverse events was the same across all BP subgroups
- The results of this study is consistent with similar studies in the non-CoA population
Commentary from Dr. Blanche Cupido (Cape Town, South Africa), chief section editor of ACHD Journal Watch:
Hypertension is common in adult patients with repaired coarctation, however, there is little data about on-treatment blood pressures and its relation to outcomes. This is a single retrospective study that assessed the relationship between on-treatment BP’s and cardiovascular outcomes (cardiovascular death) in adults with repaired coarctation of the aorta (rCoA). Patients with concomitant left ventricular inflow disease, significant residual coarctation and an aberrant origin of right subclavian artery were excluded.
The study outcome was cardiovascular mortality (myocardial infarction, sudden cardiac death, heart failure, stroke, stroke, cardiovascular hemorrhage and cardiovascular procedure). Furthermore, the relationship between on-treatment BP and adverse events was assessed.
The mean age at time of assessment was 39 years, 64% were males. Patients in the upper sBP quartiles were older, had more symptoms and had more cardiac remodeling at baseline and less likely to be on a renin angiotensin aldosterone (RAAS) antagonist or on dual antihypertensive therapy. (Table 1 below) Patients with diastolic BP’s > 90mmHg were more likely to have coronary artery disease and have advanced cardiac remodeling – they were also less likely to be on a RAAS antagonist or dual antihypertensive therapy.
The median interval from baseline to first encounter at 7.9 +/~ 3.2 years. A total of 39 patients (9%) had cardiovascular deaths. Unadjusted incidence of cardiovascular mortality was 12 per 1000 patient-years. For sBP, every group with greater blood pressures had increased risk of cardiovascular mortality – (sBP 120-129, sBP 130-139, and sBP >140, was associated with CV mortality of 5%, 12% and 39% respectively). For diastolic BP , only the group with >90mmHg was independently associated with increased cv events. Overall, there was a 7% increase in risk of cardiovascular mortality for every 5mmHg increase in sBP and a 4% increase in risk of cardiovascular mortality for every 5mmHg increase in dBP. (see figure 2 below)
Fifty-eight treatment related adverse events occurred in 43 patients during follow-up, of which all but 2 were mild. These events included: symptomatic hypotension (n=1), symptomatic bradycardia (n=4), electrolyte abnormalities (n=47) and acute kidney injury (n=6). The incidence of treatment-related adverse events was 16 per 1000 patients years. There was no significant relationship between BP quartiles and the incidence of adverse events.
This is however a single center retrospective study and a randomized trial would be advised.
