169 - Persistent hypertension in children with repaired coarctation of the aorta

Publication Number: 169.6132

Ariana Mirzada, Children's National Health System, Washington, DC, United States; Manneha A. Qazi, Howard University College of Medicine, Washington, DC, United States; Celina Brunson, Children's National Health System, Silver Spring, MD, United States; Ashraf Harahsheh, Children's National Health System, Washington, DC, United States

Background: Hypertension (HTN) is commonly seen in patients who have undergone repair for coarctation of the aorta (CoA). A 2022 systematic review found the incidence of HTN after CoA repair to be 47.3%. To this team's knowledge, there are few studies exploring non-cardiac etiologies of HTN in patients who have undergone CoA repair. This study aims to evaluate the workup for HTN in pediatric patients with repaired CoA at a large tertiary pediatric center. Our hypothesis is that children with repaired CoA who develop persistent HTN are treated with antihypertensive therapies without further workup.

Objective: Primary

Objective: To assess if non-cardiac workup is performed in patients with new or persisting HTN who have undergone repair of CoA.
Secondary

Objective: To assess if persistent HTN after repair is associated with certain factors like age, gender, clinical presentation and extracardiac abnormalities.

Design/Methods: This was a single site retrospective cohort study. Data was extracted from medical records of patients who underwent CoA repair between January 1, 2010 and December 31, 2023. 80 patients were identified, of which 68 had data available regarding blood pressure. Patients were stratified into two groups: those with persistent HTN after repair and those without. HTN was defined as systolic blood pressure greater than 95th percentile for children less than 13 years old, and as blood pressure greater than 130/80 for children 13 years and older. The two groups were compared and statistical significance was assessed as p ≤ 0.05.

Results: Of the 68 patients, 54% (N=37) had persistent HTN after repair. Of the persistent HTN group, 14% (N=5) were referred to nephrology for further workup. The remaining 86% did not have a non-cardiac workup (Urinalysis, TSH, Renal Doppler ultrasound). Anti-HTN medication use was identified in 57% (N=21) of the persistent HTN group including 3/5 (60%) of patients who had a nephrology referral. Renal Doppler ultrasound was done in 11% of the persistent HTN group and 14% had a urinalysis in their workup. There were no statistically significant differences between the two groups based on demographic and clinical features.

Conclusion(s): Patients who have undergone CoA repair often have persisting HTN and the etiology is uncertain. We found that most patients with persistent HTN after CoA repair are not referred to nephrology and do not have further workup to evaluate for secondary causes of HTN. Future prospective studies should assess the frequency of secondary HTN in this patient population and may inform if standardization is needed for HTN workup.