Hypertensive response to exercise in adult patients with repaired aortic coarctation

Timion A Meijs; Steven A Muller; Savine C S Minderhoud; Robbert J de Winter; Barbara J M Mulder; Joost P van Melle; Elke S Hoendermis; Arie P J van Dijk; Nicolaas P A Zuithoff; Gregor J Krings; Pieter A Doevendans; Wilko Spiering; Maarten Witsenburg; Jolien W Roos-Hesselink; Annemien E van den Bosch; Berto J Bouma; Michiel Voskuil

doi:10.1136/heartjnl-2021-320333

Hypertensive response to exercise in adult patients with repaired aortic coarctation

Timion A Meijs, Steven A Muller, Savine C S Minderhoud, Robbert J de Winter, Barbara J M Mulder, Joost P van Melle, Elke S Hoendermis, Arie P J van Dijk, Nicolaas P A Zuithoff, Gregor J Krings, Pieter A Doevendans, Wilko Spiering, Maarten Witsenburg, Jolien W Roos-Hesselink, Annemien E van den Bosch, Berto J Bouma, Michiel Voskuil

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objective: The clinical and prognostic implications of a hypertensive response to exercise after repair of coarctation of the aorta (CoA) remain controversial. We aimed to determine the prevalence of a hypertensive response to exercise, identify factors associated with peak exercise systolic blood pressure (SBP) and explore the association of peak exercise SBP with resting blood pressure and cardiovascular events during follow-up. Methods: From the Dutch national CONgenital CORvitia (CONCOR) registry, adults with repaired CoA who underwent exercise stress testing were included. A hypertensive response to exercise was defined as a peak exercise SBP ≥210 mm Hg in men and ≥190 mm Hg in women. Cardiovascular events consisted of coronary artery disease, stroke, aortic complications and cardiovascular death. Results: Of the original cohort of 920 adults with repaired CoA, 675 patients (median age 24 years (range 16-72 years)) underwent exercise stress testing. Of these, 299 patients (44%) had a hypertensive response to exercise. Mean follow-up duration was 10.1 years. Male sex, absence of a bicuspid aortic valve and elevated resting SBP were independently associated with increased peak exercise SBP. Peak exercise SBP was positively predictive of office SBP (β=0.11, p<0.001) and 24-hour SBP (β=0.05, p=0.03) at follow-up, despite correction for baseline SBP. During follow-up, 100 patients (15%) developed at least 1 cardiovascular event. Peak exercise SBP was not significantly associated with the occurrence of cardiovascular events (HR 0.994 (95% CI 0.987 to 1.001), p=0.11). Conclusions: A hypertensive response to exercise was present in nearly half of the patients in this large, prospective cohort of adults with repaired CoA. Risk factors for increased peak exercise SBP were male sex, absence of a bicuspid aortic valve and elevated resting SBP. Increased peak exercise SBP independently predicted hypertension at follow-up. These results support close follow-up of patients with a hypertensive response to exercise to ensure timely diagnosis and treatment of future hypertension.

Original language	English
Article number	heartjnl-2021-320333
Pages (from-to)	1121-1128
Number of pages	8
Journal	Heart
Volume	108
Issue number	14
Early online date	5 Jan 2022
DOIs	https://doi.org/10.1136/heartjnl-2021-320333
Publication status	Published - 24 Jun 2022

Keywords

aortic coarctation
congenital
heart defects
hypertension

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10.1136/heartjnl-2021-320333

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Meijs, T. A., Muller, S. A., Minderhoud, S. C. S., de Winter, R. J., Mulder, B. J. M., van Melle, J. P., Hoendermis, E. S., van Dijk, A. P. J., Zuithoff, N. P. A., Krings, G. J., Doevendans, P. A., Spiering, W., Witsenburg, M., Roos-Hesselink, J. W., van den Bosch, A. E., Bouma, B. J., & Voskuil, M. (2022). Hypertensive response to exercise in adult patients with repaired aortic coarctation. Heart, 108(14), 1121-1128. Article heartjnl-2021-320333. https://doi.org/10.1136/heartjnl-2021-320333

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title = "Hypertensive response to exercise in adult patients with repaired aortic coarctation",

abstract = "Objective: The clinical and prognostic implications of a hypertensive response to exercise after repair of coarctation of the aorta (CoA) remain controversial. We aimed to determine the prevalence of a hypertensive response to exercise, identify factors associated with peak exercise systolic blood pressure (SBP) and explore the association of peak exercise SBP with resting blood pressure and cardiovascular events during follow-up. Methods: From the Dutch national CONgenital CORvitia (CONCOR) registry, adults with repaired CoA who underwent exercise stress testing were included. A hypertensive response to exercise was defined as a peak exercise SBP ≥210 mm Hg in men and ≥190 mm Hg in women. Cardiovascular events consisted of coronary artery disease, stroke, aortic complications and cardiovascular death. Results: Of the original cohort of 920 adults with repaired CoA, 675 patients (median age 24 years (range 16-72 years)) underwent exercise stress testing. Of these, 299 patients (44%) had a hypertensive response to exercise. Mean follow-up duration was 10.1 years. Male sex, absence of a bicuspid aortic valve and elevated resting SBP were independently associated with increased peak exercise SBP. Peak exercise SBP was positively predictive of office SBP (β=0.11, p<0.001) and 24-hour SBP (β=0.05, p=0.03) at follow-up, despite correction for baseline SBP. During follow-up, 100 patients (15%) developed at least 1 cardiovascular event. Peak exercise SBP was not significantly associated with the occurrence of cardiovascular events (HR 0.994 (95% CI 0.987 to 1.001), p=0.11). Conclusions: A hypertensive response to exercise was present in nearly half of the patients in this large, prospective cohort of adults with repaired CoA. Risk factors for increased peak exercise SBP were male sex, absence of a bicuspid aortic valve and elevated resting SBP. Increased peak exercise SBP independently predicted hypertension at follow-up. These results support close follow-up of patients with a hypertensive response to exercise to ensure timely diagnosis and treatment of future hypertension.",

keywords = "aortic coarctation, congenital, heart defects, hypertension",

author = "Meijs, {Timion A} and Muller, {Steven A} and Minderhoud, {Savine C S} and {de Winter}, {Robbert J} and Mulder, {Barbara J M} and {van Melle}, {Joost P} and Hoendermis, {Elke S} and {van Dijk}, {Arie P J} and Zuithoff, {Nicolaas P A} and Krings, {Gregor J} and Doevendans, {Pieter A} and Wilko Spiering and Maarten Witsenburg and Roos-Hesselink, {Jolien W} and {van den Bosch}, {Annemien E} and Bouma, {Berto J} and Michiel Voskuil",

year = "2022",

month = jun,

day = "24",

doi = "10.1136/heartjnl-2021-320333",

language = "English",

volume = "108",

pages = "1121--1128",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group",

number = "14",

}

Meijs, TA, Muller, SA, Minderhoud, SCS, de Winter, RJ, Mulder, BJM, van Melle, JP, Hoendermis, ES, van Dijk, APJ, Zuithoff, NPA, Krings, GJ, Doevendans, PA , Spiering, W, Witsenburg, M, Roos-Hesselink, JW, van den Bosch, AE, Bouma, BJ & Voskuil, M 2022, 'Hypertensive response to exercise in adult patients with repaired aortic coarctation', Heart, vol. 108, no. 14, heartjnl-2021-320333, pp. 1121-1128. https://doi.org/10.1136/heartjnl-2021-320333

TY - JOUR

T1 - Hypertensive response to exercise in adult patients with repaired aortic coarctation

AU - Meijs, Timion A

AU - Muller, Steven A

AU - Minderhoud, Savine C S

AU - de Winter, Robbert J

AU - Mulder, Barbara J M

AU - van Melle, Joost P

AU - Hoendermis, Elke S

AU - van Dijk, Arie P J

AU - Zuithoff, Nicolaas P A

AU - Krings, Gregor J

AU - Doevendans, Pieter A

AU - Spiering, Wilko

AU - Witsenburg, Maarten

AU - Roos-Hesselink, Jolien W

AU - van den Bosch, Annemien E

AU - Bouma, Berto J

AU - Voskuil, Michiel

PY - 2022/6/24

Y1 - 2022/6/24

N2 - Objective: The clinical and prognostic implications of a hypertensive response to exercise after repair of coarctation of the aorta (CoA) remain controversial. We aimed to determine the prevalence of a hypertensive response to exercise, identify factors associated with peak exercise systolic blood pressure (SBP) and explore the association of peak exercise SBP with resting blood pressure and cardiovascular events during follow-up. Methods: From the Dutch national CONgenital CORvitia (CONCOR) registry, adults with repaired CoA who underwent exercise stress testing were included. A hypertensive response to exercise was defined as a peak exercise SBP ≥210 mm Hg in men and ≥190 mm Hg in women. Cardiovascular events consisted of coronary artery disease, stroke, aortic complications and cardiovascular death. Results: Of the original cohort of 920 adults with repaired CoA, 675 patients (median age 24 years (range 16-72 years)) underwent exercise stress testing. Of these, 299 patients (44%) had a hypertensive response to exercise. Mean follow-up duration was 10.1 years. Male sex, absence of a bicuspid aortic valve and elevated resting SBP were independently associated with increased peak exercise SBP. Peak exercise SBP was positively predictive of office SBP (β=0.11, p<0.001) and 24-hour SBP (β=0.05, p=0.03) at follow-up, despite correction for baseline SBP. During follow-up, 100 patients (15%) developed at least 1 cardiovascular event. Peak exercise SBP was not significantly associated with the occurrence of cardiovascular events (HR 0.994 (95% CI 0.987 to 1.001), p=0.11). Conclusions: A hypertensive response to exercise was present in nearly half of the patients in this large, prospective cohort of adults with repaired CoA. Risk factors for increased peak exercise SBP were male sex, absence of a bicuspid aortic valve and elevated resting SBP. Increased peak exercise SBP independently predicted hypertension at follow-up. These results support close follow-up of patients with a hypertensive response to exercise to ensure timely diagnosis and treatment of future hypertension.

AB - Objective: The clinical and prognostic implications of a hypertensive response to exercise after repair of coarctation of the aorta (CoA) remain controversial. We aimed to determine the prevalence of a hypertensive response to exercise, identify factors associated with peak exercise systolic blood pressure (SBP) and explore the association of peak exercise SBP with resting blood pressure and cardiovascular events during follow-up. Methods: From the Dutch national CONgenital CORvitia (CONCOR) registry, adults with repaired CoA who underwent exercise stress testing were included. A hypertensive response to exercise was defined as a peak exercise SBP ≥210 mm Hg in men and ≥190 mm Hg in women. Cardiovascular events consisted of coronary artery disease, stroke, aortic complications and cardiovascular death. Results: Of the original cohort of 920 adults with repaired CoA, 675 patients (median age 24 years (range 16-72 years)) underwent exercise stress testing. Of these, 299 patients (44%) had a hypertensive response to exercise. Mean follow-up duration was 10.1 years. Male sex, absence of a bicuspid aortic valve and elevated resting SBP were independently associated with increased peak exercise SBP. Peak exercise SBP was positively predictive of office SBP (β=0.11, p<0.001) and 24-hour SBP (β=0.05, p=0.03) at follow-up, despite correction for baseline SBP. During follow-up, 100 patients (15%) developed at least 1 cardiovascular event. Peak exercise SBP was not significantly associated with the occurrence of cardiovascular events (HR 0.994 (95% CI 0.987 to 1.001), p=0.11). Conclusions: A hypertensive response to exercise was present in nearly half of the patients in this large, prospective cohort of adults with repaired CoA. Risk factors for increased peak exercise SBP were male sex, absence of a bicuspid aortic valve and elevated resting SBP. Increased peak exercise SBP independently predicted hypertension at follow-up. These results support close follow-up of patients with a hypertensive response to exercise to ensure timely diagnosis and treatment of future hypertension.

KW - aortic coarctation

KW - congenital

KW - heart defects

KW - hypertension

UR - http://www.scopus.com/inward/record.url?scp=85127453874&partnerID=8YFLogxK

U2 - 10.1136/heartjnl-2021-320333

DO - 10.1136/heartjnl-2021-320333

M3 - Article

C2 - 34987066

SN - 1355-6037

VL - 108

SP - 1121

EP - 1128

JO - Heart

JF - Heart

IS - 14

M1 - heartjnl-2021-320333

ER -

Hypertensive response to exercise in adult patients with repaired aortic coarctation

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