From the Guidelines
Coarctation of the aorta leads to hypertension in the upper limbs, specifically the arms. This condition is characterized by a narrowing of the aorta, typically just distal to the left subclavian artery, which restricts blood flow to the lower body 1. The obstruction causes increased pressure proximal to the narrowing, resulting in elevated blood pressure in the arms, head, and neck. Meanwhile, the reduced blood flow beyond the narrowing leads to normal or decreased blood pressure in the legs. Some key points to consider in the diagnosis and management of coarctation of the aorta include:
- Measuring blood pressure in both arms and one of the lower extremities is recommended 1
- Guideline-directed medical therapy is recommended for the treatment of hypertension in patients with coarctation of the aorta 1
- Endovascular stenting or open surgical repair of the coarctation may be necessary in patients with significant native or recurrent coarctation and hypertension 1 The persistent upper limb hypertension can lead to serious complications, including left ventricular hypertrophy, heart failure, coronary artery disease, and cerebrovascular events if left untreated 1. Physicians often check for diminished or delayed femoral pulses compared to radial pulses (radio-femoral delay) as part of the physical examination when suspecting this condition. It is essential to monitor and manage hypertension in patients with coarctation of the aorta to prevent long-term complications and improve quality of life 1.
From the Research
Coarctation of the Aorta and Hypertension
Coarctation of the aorta is a condition characterized by the narrowing of the aorta, which can lead to hypertension in certain limbs. The evidence suggests that this condition typically results in:
- High blood pressure in the upper part of the body, specifically in the arms 2, 3, 4
- Decreased blood pressure in the lower part of the body, specifically in the legs 2, 3, 4
- A systolic blood pressure difference of 20 mm Hg or more between the arms and legs 2
Limbs Affected by Hypertension
The limbs affected by hypertension due to coarctation of the aorta are:
- Arms: High blood pressure is typically observed in the arms, with systolic hypertension being more common in the upper part of the body 3, 5
- Legs: Decreased blood pressure is typically observed in the legs, with a systolic blood-pressure gradient between the arm and the leg being a common finding 2, 3, 5
Factors Influencing Hypertension
Several factors can influence the development of hypertension in patients with coarctation of the aorta, including:
- Age: Older age has been associated with residual hypertension post-stenting 6
- Body mass index (BMI): Higher BMI has been associated with residual hypertension post-stenting 6
- Aortic arch anatomy: Abnormal arch geometry, such as a gothic arch, has been associated with residual hypertension post-stenting 6
- Stent length: Longer stent length has been associated with residual hypertension post-stenting 6