Antihypertensive therapy of late arterial hypertension in children following successful coarctation correction.

BACKGROUNG: Late arterial hypertension (AH) is the most significant complication of coarctation of the aorta (CoA). Only a few clinical studies described antihypertensive treatment of late AH following successful CoA repair. The primary objective of this multicentre cross-sectional study was to describe real-life antihypertensive therapy for late AH in children after hemodynamically successful CoA repair. The secondary objective was to describe antihypertensive therapy used within different haemodynamic phenotypes of AH. METHOD: Blood pressure status, echocardiographic parameters and central blood pressure measurements were evaluated in 110 children aged 6-18 years following successful CoA repair with right arm blood pressure not exceeding leg blood pressure by at least 20 mmHg. RESULTS: AH was found in 62 (56%) patients including 47 who were already treated and 15 with new diagnosed AH of whom seven presented with masked hypertension. Among treated patients, 10 presented with masked hypertension. The dominant phenotype of AH among patients with uncontrolled AH was isolated systolic hypertension (32 patients out of 37; 87.5%). AH was controlled in 53% of treated patients. Fifty-three percent of hypertensive patients had elevated central SBP and 39% had left ventricular hypertrophy with various left ventricle geometry patterns, 23% of them had both. ß-adrenergic receptor blockers were the most used antihypertensive drugs followed by angiotensin-converting enzyme inhibitors with doses within the lower recommended range. CONCLUSION: High prevalence of uncontrolled AH despite successful CoA repair and use of relatively low doses of antihypertensive drugs indicates the need of close blood pressure monitoring and more intensive and combined antihypertensive therapy.

Multi-centre cross-sectional study on vascular remodelling in children following successful coarctation correction.

Coarctation of the aorta is an arteriopathy with life-long sequelae, with remarkably increased cardiovascular events in young adults even after successful repair and despite blood pressure status. There are data on arterial remodelling in adults after coarctation correction, however, these data are scarce in childhood. Thus, the aim of this cross-sectional study was to evaluate changes in arterial wall function and morphology in children following successful coarctation repair and to compare these changes among patients with different blood pressure status and coarctation correction modes. Blood pressure status, echocardiographic parameters, arterial wall structure and stiffness, endothelial function and central blood pressure measurements were evaluated in 110 children aged 6-18 years following successful coarctation repair with right arm blood pressure not exceeding leg blood pressure by ≥20 mmHg. The prevalence of arterial hypertension was 50%. The mean carotid intima-media thickness SDS was 3.1 ± 1.5 and above 1.65 SDS in 91 of 110 patients. Increased right carotid intima-media thickness was associated with left ventricular hypertrophy, office blood pressure difference between leg and right arm, recoarctation in the past and interventional coarctation correction. Increased local common carotid artery stiffness was associated with increased pulse pressure and central systolic blood pressure. Potentially decreased endothelial function was related to a slight increase of peak and mean systolic gradient in the descending aorta. After successful coarctation repair and with a low blood pressure gradient, children still have a high prevalence of arterial hypertension and significant arterial remodelling, indicating accelerated biological age and advanced arteriosclerosis.

Prevalence of arterial hypertension, hemodynamic phenotypes, and left ventricular hypertrophy in children after coarctation repair: a multicenter cross-sectional study.

BACKGROUND: This study aimed to evaluate hemodynamic phenotypes and prevalence of left ventricular hypertrophy in children after coarctation repair with right arm and leg blood pressure difference < 20 mmHg. Secondary objectives were analysis of effects of age at intervention, residual gradient across the descending aorta, and type of correction. METHODS: Blood pressure status and left ventricular hypertrophy were diagnosed according to European Society of Hypertension 2016 guidelines. RESULTS: Of 90 patients with a median age 12.5 (8.9-15.8) years, 8.5 (6.0-11.8) years after coarctation repair who were included, 42 (46.7%) were hypertensive. Isolated systolic hypertension dominated among 29 hypertensive patients with uncontrolled or masked hypertension (25 of 29; 86.2%). Of the 48 patients with office normotension, 14.6% (7) had masked hypertension, 8.3% (4) had ambulatory prehypertension, and 54.2% (26) were truly normotensive. Left ventricular hypertrophy was diagnosed in 29 patients (32.2%), including 14 of 42 (33.3%) hypertensive and 15 of 48 (31.3%) normotensive patients. The peak systolic gradient across the descending aorta was greater in hypertensive subjects (33.3 ± 12.7 mmHg) compared with normotensive subjects (25 ± 8.2 mmHg, p = 0.0008). Surgical correction was performed earlier than percutaneous intervention (p < 0.0001) and dominated in 40 of 48 (83.3%) normotensive versus 24 of 42 (57.1%) hypertensive patients (p = 0.006). CONCLUSIONS: Arterial hypertension with isolated systolic hypertension as the dominant phenotype and left ventricular hypertrophy are prevalent even after successful coarctation repair. Coarctation correction from the age of 9 years and older was associated with a higher prevalence of hypertension.

[Coping styles in patients with systolic heart failure]. / Style radzenia sobie ze stresem u mezczyzn z lagodna skurczowa niewydolnoscia serca.

INTRODUCTION: Inadequate coping with stress, in the course of severe disease (e.g. heart failure, HF), promotes the development of depressive symptoms and disadvantageous behaviours (e.g. non-compliance). METHOD: We examined coping styles in men with systolic HF (n=46, age: 60+/-12 years), and related them to clinical status and depressive symptoms. Patients filled-in Coping Inventory for Stressful Situations (CISS) distinguishing: task-oriented (ZA), emotional (EM) and avoidance (UN) styles of coping. Style 'UN' has two subtypes: engaging in alternative activities (ACZ) or seeking for social contacts (PKT). RESULTS: 59% of patients showed a tendency towards all 3 styles of coping. There were the following prevalences of domination of particular coping styles: ZA (35%), UN (28%), EM (7%). 30% of cases did not show domination of any style. The higher tendency to EM style was accompanied by the greater severity of depressive symptoms, both affective-cognitive and somatic ones (p<0.05). CONCLUSIONS: Assessment of coping styles may be helpful in educational programs or psychotherapy addressed to patients with HF experiencing psychological burden due to chronic physical illness.

Health locus of control and the sense of self-efficacy in patients with systolic heart failure: a pilot study.

BACKGROUND: Treatment of heart failure (HF) requires the lifelong adherence to medical self-care regimes. The objective of this study was to examine health-control beliefs and the sense of self-efficacy (psychological features particularly important for efficient compliance among patients suffering from chronic diseases) in patients with systolic HF in relation to clinical status and depressive symptoms. SUBJECTS AND METHODS: Sixty-six consecutive patients with chronic systolic HF, hospitalized in the Centre for Heart Diseases, Military Hospital (94% men, age: 61 ± 11 years, ischemic etiology: 63%, left ventricular ejection fraction: 32% ± 12%), filled in (during their hospital stay): (1) the Multidimensional Health Locus of Control Scale measuring three possible localizations of health control: "internality" (ie, the belief that health status depends only on personal decisions and behaviors); "powerful others externality" ([PHLC subscale] ie, the conviction that health depends on "powerful people" such as doctors, family members, close friends), and "chance externality" (ie, belief that health status is determined by chance, fate, or luck), and (2) the Generalized Self-Efficacy Scale. The results obtained by HF patients were compared to those reported by patients with other chronic diseases and healthy subjects. RESULTS: In patients with HF, internality was similar to values obtained by patients with diabetes, men after myocardial infarction, and women after mastectomy; and was lower than in healthy subjects. Powerful others externality was more pronounced in patients with HF as compared to other groups of patients and healthy people. Only women after mastectomy had higher scores of PHLC. In patients with HF, chance externality was similar to values reported in patients with renal failure, men after myocardial infarction, and women after mastectomy; and was less pronounced than in healthy subjects. The majority (77%) of patients with HF were characterized by a high sense of self-efficacy (>the 7th sten score), having the highest sense of self-efficacy among patients with other chronic diseases and healthy controls. Higher internality was accompanied by higher sense of self-efficacy (P < 0.05) in patients with HF. Subjects with high plasma N-terminal pro-B type natriuretic peptide (reflecting the disease severity) had the least pronounced internality (P < 0.05), whereas those with more advance depressive symptoms had the lower sense of self-efficacy (P = < 0.05). CONCLUSION: Patients with systolic HF demonstrate a conviction that other people, including physicians, have a large influence on their health status, and at the same time are aware of the efficacy of their own activities in coping with the disease. Such a configuration of psychological features seems to be beneficial in the context of the developing modern strategies, which due to the improved cooperation between the physicians and the patients could enhance the compliance in patients with HF.