Cargando…

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

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Roeleveld, Peter P., Zwijsen, Eline G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439537/
https://www.ncbi.nlm.nih.gov/pubmed/28520538
http://dx.doi.org/10.1177/2150135117690104
_version_ 1783237958584762368
author Roeleveld, Peter P.
Zwijsen, Eline G.
author_facet Roeleveld, Peter P.
Zwijsen, Eline G.
author_sort Roeleveld, Peter P.
collection PubMed
description 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.
format Online
Article
Text
id pubmed-5439537
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-54395372017-06-02 Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children Roeleveld, Peter P. Zwijsen, Eline G. World J Pediatr Congenit Heart Surg Original Articles 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. SAGE Publications 2017-05-18 2017-05 /pmc/articles/PMC5439537/ /pubmed/28520538 http://dx.doi.org/10.1177/2150135117690104 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by-nc/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Articles
Roeleveld, Peter P.
Zwijsen, Eline G.
Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children
title Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children
title_full Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children
title_fullStr Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children
title_full_unstemmed Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children
title_short Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children
title_sort treatment strategies for paradoxical hypertension following surgical correction of coarctation of the aorta in children
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439537/
https://www.ncbi.nlm.nih.gov/pubmed/28520538
http://dx.doi.org/10.1177/2150135117690104
work_keys_str_mv AT roeleveldpeterp treatmentstrategiesforparadoxicalhypertensionfollowingsurgicalcorrectionofcoarctationoftheaortainchildren
AT zwijsenelineg treatmentstrategiesforparadoxicalhypertensionfollowingsurgicalcorrectionofcoarctationoftheaortainchildren