Arterial hypertension in children after aortic coarctation repair: current challenges for diagnostics and treatment

Coarctation of the aorta is a well-studied congenital heart disease. Our understanding of this congenital heart disease evolves every year from obstructive aortic lesions to systemic dysfunction of the cardiovascular system. In the past two decades, there has been a progressive decrease in mortality and early postoperative complications of newborns and infants with aortic coarctation. However, these patients with coarctation of aorta have a high risk of postoperative complications in the long-term period, despite successful correction at an early age. The review focuses on the issues mainly related to blood pressure. Arterial hypertension has been reported to occur in up to 90% of patients, and is considered as the main cause of premature cardiovascular diseases. The development of arterial hypertension in patients after correction of aortic coarctation is likely to be multifactorial and may be associated with the changes in elastic properties of the aorta wall, presence of residual obstruction, changes in the aortic arch geometry, immune-inflammatory disorders and changes in the regulation of renin-angiotensin and baroreceptors. Also described are the prevalence and pathophysiology of arterial hypertension in children who have undergone aortic coarctation repair. Due attention is given to the issues of accurate blood pressure measurement at an early stage of arterial hypertension. Although the patterns for diagnostics of arterial hypertension in adults are well established, we highlight the issues of premature cardiovascular events development in children and describe the techniques, which help provide complementary information for cardiovascular assessment in this group of patients.