Skip to main content
Log in

Exercise capacity in young adults with hypertension and systolic blood pressure difference between right arm and leg after repair of coarctation of the aorta

  • Original Article
  • Published:
European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

Coarctation of the aorta represents 5–7% of congenital heart defects. Symptoms and prognosis depend on the degree of stenosis, age at surgery, surgical method and the presence of other heart defects. Postoperative complications are hypertension, restenosis and an abnormal blood pressure response during exercise. This study includes 41 patients, 15–40 years old, operated in the period 1975–1996. All were exercised on a treadmill until maximal oxygen consumption was achieved. Blood pressure was measured in the right arm and leg before and immediately after exercise, and in the right arm during exercise. Oxygen consumption was monitored and we defined an aerobic phase, an isocapnic buffering phase and a hypocapnic hyperventilation phase. The resting systolic blood pressure correlates with the resting systolic blood pressure difference between right arm and leg. A resting systolic blood pressure difference between the right arm and leg of 0.13 kPa (1 mmHg) to 2.67 kPa (20 mmHg) corresponds with a slight increase in resting systolic blood pressure. This rise in blood pressure increases the aerobic phase of the exercise test, helping the patients to achieve higher maximal oxygen consumption. A resting systolic blood pressure difference of more than 2.67 kPa (20 mmHg) corresponds with severe hypertension and causes reduction in the aerobic phase and maximal oxygen consumption. Resting systolic blood pressure and resting systolic blood pressure difference between the right arm and leg are not indicators for blood pressure response during exercise. Exercise testing is important to reveal exercise-induced hypertension and to monitor changes in transition from aerobic to anaerobic exercise and limitation to exercise capacity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1a–c
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  • Allen HD, Beekman RH, Garson A Jr. Hijazi ZM, Mullins C, O’Laughlin, Taubert KA (1998) Pediatric therapeutic cardiac catheterization. A statement for healthcare professionals from the council on cardiovascular disease in the young, American Heart Association. Circulation 97:609–625

    CAS  PubMed  Google Scholar 

  • Alpert BS, Bain HH, Balfe JW, Kidd BS, Olley PM (1979) Role of the renin–angiotensin–aldosterone system in hypertensive children with coarctation of the aorta. Am J Cardiol 43:828–834

    Article  CAS  PubMed  Google Scholar 

  • Beaver WL, Wasserman K, Whipp BJ (1986) A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 60:2020–2027

    CAS  PubMed  Google Scholar 

  • Bharati S, Lev M (1986) The surgical anatomy of the heart in tubular hypoplasia of the transverse aorta (preductal coarctation). J Thorac Cardiovasc Surg 91:79–85

    CAS  PubMed  Google Scholar 

  • Borow KM, Colan SD, Neumann A (1985) Altered left ventricular mechanics in patients with valvular aortic stenosis and coarction of the aorta: effects on systolic performance and late outcome. Circulation 72:515–522

    CAS  PubMed  Google Scholar 

  • Clarkson PM, Nicholson MR, Barratt-Boyes BG, Neutze JM, Whitlock RM (1983) Results after repair of coarctation of the aorta beyond infancy: a 10 to 28 year follow-up with particular reference to late systemic hypertension. Am J Cardiol 51(9):1481–1488

    CAS  PubMed  Google Scholar 

  • Engvall J, Karlsson M, Ask P, Loyd D, Nylander E, Wranne B (1994) Importance of collateral vessels in aortic coarctation: computer simulation at rest and exercise using transmission line elements. Med Biol Eng Comput 32[Suppl 4]:S115–122

  • Engvall J, Sonnhag C, Nylander E, Stenport G, Karlsson E, Wranne B (1995) Arm–ankle systolic blood pressure difference at rest and after exercise in the assessment of aortic coarctation. Br Heart J 73:270–276

    CAS  PubMed  Google Scholar 

  • Gardiner HM, Celermajer DS, Sorensen KE, Georgakopoulos D, Robinson J, Thomas O, Deanfield JE (1994) Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood. Circulation 89:1745–1750

    CAS  PubMed  Google Scholar 

  • Griffin SE, Robergs RA, Heyward VH (1997) Blood pressure measurement during exercise: a review. Med Sci Sports Exerc 29:149–159

    CAS  PubMed  Google Scholar 

  • Guenthard J, Wyler F (1995) Exercise-induced hypertension in the arms due to impaired arterial reactivity after successful coarctation resection. Am J Cardiol 75:814–817

    Article  CAS  Google Scholar 

  • Guenthard J, Wyler F (1996) Doppler echocardiography during exercise to predict residual narrowing of the aorta after coarctation resection. Pediatr Cardiol 17:370–374

    Article  CAS  PubMed  Google Scholar 

  • Guenthard J, Zumsteg U, Wyler F (1996) Arm–leg pressure gradients on late follow-up after coarctation repair. Possible causes and implications. Eur Heart J 17:1572–1575

    CAS  PubMed  Google Scholar 

  • Kaemmerer H, Oelert F, Bahlmann J, Blucher S, Meyer GP, Mugge A (1998) Arterial hypertension in adults after surgical treatment of aortic coarctation. Thorac Cardiovasc Surg 46:121–125

    CAS  PubMed  Google Scholar 

  • Kappetein PA, Guit GL, Bogers AJ, Weeda HW, Zwinderman KH, Schonberger JP, Huysmans HA (1993) Noninvasive long-term follow-up after coarctation repair. Ann Thorac Surg 55:1153–1159

    CAS  PubMed  Google Scholar 

  • Kimball TR, Reynolds JM, Mays WA, Khoury P, Claytor RP, Daniels SR (1994) Persistent hyperdynamic cardiovascular state at rest and during exercise in children after successful repair of coarctation of the aorta. J Am Coll Cardiol 24:194–200

    CAS  PubMed  Google Scholar 

  • Krogmann ON, Kramer HH, Rammos S, Heusch A, Bourgeois M (1993) Non-invasive evaluation of left ventricular systolic function late after coarctation repair: influence of early vs late surgery. Eur Heart J 14:764–769

    CAS  PubMed  Google Scholar 

  • Leandro J, Smallhorn JF, Benson L, Musewe N, Balfe JW, Dyck JD, West L, Freedom R (1992) Ambulatory blood pressure monitoring and left ventricular mass and function after successful surgical repair of coarctation of the aorta. J Am Coll Cardiol 20:197–204

    CAS  PubMed  Google Scholar 

  • Markel H, Rocchini AP, Beekman RH, Martin J, Palmisano J, Moorehead C, Rosenthal A (1986) Exercise-induced hypertension after repair of coarctation of the aorta: arm versus leg exercise. J Am Coll Cardiol 8:165–171

    CAS  PubMed  Google Scholar 

  • Moskowitz WB, Schieken RM, Mosteller M, Bossano R (1990) Altered systolic and diastolic function in children after “successful” repair of coarctation of the aorta. Am Heart J 120:103–109

    Article  CAS  PubMed  Google Scholar 

  • Ong CM, Canter CE, Gutierrez FR, Sekarski DR, Goldring DR (1992) Increased stiffness and persistent narrowing of the aorta after successful repair of coarctation of the aorta: relationship to left ventricular mass and blood pressure at rest and with exercise. Am Heart J 123:1594–1600

    Article  CAS  PubMed  Google Scholar 

  • Oshima Y, Miyamoto T, Tanaka S, Wadazumi T, Kurihara N, Fujimoto S (1997) Relationship between isocapnic buffering and maximal aerobic capacity in athletes. Eur J Appl Physiol 76:409–414

    Article  CAS  Google Scholar 

  • Palatini P, Bongiovi S, Mario L, Schiraldi C, Mos L, Pessina AC (1995) Above-normal left ventricular systolic performance during exercise in young subjects with mild hypertension. Eur Heart J 16:232–242

    CAS  PubMed  Google Scholar 

  • Parker FB, Farrell B, Streeten DH, Blackman MS, Sondheimer HM, Anderson GH (1980) Hypertensive mechanisms in coarctation of the aorta. Further studies of the renin-angiotensin system. J Thorac Cardiovasc Surg 80:568–573

    PubMed  Google Scholar 

  • Parker FB, Streeten DH, Farrell B, Blackman MS, Sondheimer HM, Anderson GH (1982) Preoperative and postoperative renin levels in coarctation of the aorta. Circulation 66:513–514

    PubMed  Google Scholar 

  • Presbitero P, Demarie D, Villani M, Perinetto EA, Riva G, Orzan F, Bobbio M, Morea M, Brusca A (1987) Long term results (15–30 years) of surgical repair of aortic coarctation. Br Heart J 57:462–467

    CAS  PubMed  Google Scholar 

  • Quaegebeur JM, Jonas RA, Weinberg AD, Blackstone EH, Kirklin JW (1994) Outcomes in seriously ill neonates with coarctation of the aorta. A multiinstitutional study. J Thorac Cardiovasc Surg 108:841–851

    CAS  PubMed  Google Scholar 

  • Rhodes J, Geggel RL, Marx GR, Bevilacqua L, Dambach YB, Hijazi ZM (1997) Excessive anaerobic metabolism during exercise after repair of aortic coarctation. J Pediatr 131:210–214

    CAS  PubMed  Google Scholar 

  • Sharma S, Maron BJ, Whyte G, Firoozi S, Elliott PM, McKenna WJ (2002) Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete’s heart and hypertrophic cardiomyopathy. J Am Coll Cardiol 40(8):1431–1436

    Article  PubMed  Google Scholar 

  • Sigurdardottir LY, Helgason H (1996) Exercise-induced hypertension after corrective surgery for coarctation of the aorta. Pediatr Cardiol 17:301–307

    Article  CAS  PubMed  Google Scholar 

  • Stewart AB, Ahmed R, Travill CM, Newman CG (1993) Coarctation of the aorta life and health 20–44 years after surgical repair. Br Heart J 69:65–70

    CAS  PubMed  Google Scholar 

  • Tantengco MV, Ross RD, Humes RA, Sullivan NM, Joshi VM, Clapp SK, Epstein ML (1997) Enhanced resting left ventricular filling in patients with successful coarctation repair and exercise-induced hypertension. Am Heart J 134:1082–1088

    CAS  PubMed  Google Scholar 

  • Thu K, Segadal L, Kvitting P, Greve G (1999) Patients surgically treated for aortic coarctation. Tidsskr Nor Laegeforen 119:2162–2165

    CAS  PubMed  Google Scholar 

  • Wasserman K, Stringer WW, Casaburi R, Koike A, Cooper CB (1994) Determination of the anaerobic threshold by gas exchange: biochemical considerations, methodology and physiological effects. Z Kardiol 83[Suppl 3]:1–12

    Google Scholar 

  • Weber HS, Cyran SE, Grzeszczak M, Myers JL, Gleason MM, Baylen BG (1993) Discrepancies in aortic growth explain aortic arch gradients during exercise. J Am Coll Cardiol 21:1002–1007

    CAS  PubMed  Google Scholar 

  • Wendel H, Teien D, Human DG, Nanton MA (1992) Assessment of blood pressures and gradients by automated blood pressure device compared to invasive measurements in patients previously operated on for coarctation of the aorta. Clin Physiol 12:155–162

    CAS  PubMed  Google Scholar 

  • Wu JL, Leung MP, Karlberg J, Chiu C, Lee J, Mok CK (1995) Surgical repair of coarctation of the aorta in neonates: factors affecting early mortality and re-coarctation. Cardiovasc Surg 3:573–578

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was financially supported by the Norwegian Research Council and the Bergen Heart Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gottfried Greve.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Instebø, A., Norgård, G., Helgheim, V. et al. Exercise capacity in young adults with hypertension and systolic blood pressure difference between right arm and leg after repair of coarctation of the aorta. Eur J Appl Physiol 93, 116–123 (2004). https://doi.org/10.1007/s00421-004-1180-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00421-004-1180-8

Keywords

Navigation