EXERCISE-INDUCED HYPERTENSION IN THE ARMS DUE TO IMPAIRED ARTERIAL REACTIVITY AFTER SUCCESSFUL COARCTATION RESECTION

Exercise-induced hypertension of the arms is a well-known late complic ation after coarctation repair. Residual narrowing at the anastomosis site as well as abnormalities of the precoarctation arterial system ma y be the cause of this problem. Blood pressure response to exercise an d flow-mediated arterial dilatation of the arms and legs were studied in 29 young adults after successful coarctectomy in childhood and comp ared with 13 control subjects, peak exercise systolic blood pressure w as significantly higher in patients than in control subjects: 238 vers us 199 mm Hg (9 = 0.007). Bath 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 patien ts compared with that in control subjects: 4.2% (range 0% to 9.4%) ver sus 9.4% (range 3.7% to 1.6%) (p <0.0001). Flow-mediated dilatation of the femoral artery was similar in both groups. Dilatation of the brac hial artery was inversely correlated to peak exercise systolic pressur e in the study patients Ir = -0.427, p = 0.02), A positive arm-leg exe rcise 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 coarc tation repair rs caused by impaired arterial reactivity, which results from structural or functional abnormality, or both.