Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May;8(3):321-331.
doi: 10.1177/2150135117690104.

Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children

Peter P Roeleveld  1 , Eline G Zwijsen  1
Affiliations

Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children

Peter P Roeleveld et al. World J Pediatr Congenit Heart Surg. 2017 May.

Abstract

Background: Paradoxical hypertension after repair of coarctation of the aorta is a well-known phenomenon. The pathogenesis involves the activation of the sympathetic nervous system (first phase) and renin-angiotensin system (second phase). Only a limited number of different treatment strategies have been published in the literature, without any comparative studies.

Methods: Our aim was to describe the current international practice variation surrounding pharmacological treatment currently being employed to treat paradoxical hypertension following the repair of coarctation of the aorta in children. We performed an online survey among 197 members of the Pediatric Cardiac Intensive Care Society. We also conducted a systematic review of the literature regarding the treatment of paradoxical hypertension.

Results: Eighty-eight people (45%), from 62 different centers, responded and answered the questions regarding blood pressure control. Nitroprusside is the first drug of choice for initial blood pressure control in 66% of respondents, esmolol in 11%, labetalol in 11%, and angiotensin-converting enzyme inhibitors (ACEIs) are used by 3% of respondents. For oral blood pressure control after discharge from the pediatric intensive care unit, 75% of respondents use ACEIs, 18% use labetalol, and 12% use other beta-blockers (propranolol, carvedilol, atenolol, metoprolol). The systematic review identified 14 articles reporting pharmacological treatment of direct postoperative hypertension following coarctation repair.

Conclusion: There is wide practice variability, due to the lack of sufficient compelling evidence. The majority (66%) of caregivers use nitroprusside to control blood pressure in the acute postoperative phase. The ACEIs are the drug of choice for chronic blood pressure control.

Keywords: child; coarctation of the aorta; paradoxical hypertension; review; survey; treatment.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

    1. Sealy WC. Paradoxical hypertension after repair of coarctation of the aorta: a review of its causes. Ann Thorac Surg. 1990;50(2):323–329. - PubMed
    1. O’Sullivan J. Late hypertension in patients with repaired aortic coarctation. Curr Hypertens Rep. 2014;16(3):421. - PubMed
    1. Dhull RS, Baracco R, Jain A, Mattoo TK. Pharmacologic treatment of pediatric hypertension. Curr Hypertens Rep. 2016;18(4):32. - PubMed
    1. National High Blood Pressure Education Program Working Group on High Blood Pressure in, children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 suppl 4th Report):555–576. - PubMed
    1. Choy M, Rocchini AP, Beekman RH, et al. Paradoxical hypertension after repair of coarctation of the aorta in children: balloon angioplasty versus surgical repair. Circulation. 1987;75(6):1186–1191. - PubMed

Publication types

Substances

LinkOut - more resources