Exercise Hypertension Post-coarctation — EECC MCQ

Correct answer: D — Exaggerated hypertensive response to exercise occurs in 30-60% of post-coarctation repair patients even with normal resting BP — it reflects residual aortic arch abnormalities, increased arterial stiffness, and baroreceptor dysfunction; it is an independent predictor of future sustained hypertension and cardiovascular events

Exercise-induced hypertension (EIH) after coarctation repair is well-described and clinically significant. The 2020 ESC ACHD Guidelines define EIH as: peak exercise SBP >220 mmHg (adults) or >95th percentile for age (children). Mechanisms: (1) residual arch hypoplasia (not correctable by focal repair); (2) increased pre-coarctation aortic stiffness; (3) impaired baroreceptor sensitivity; (4) RAAS activation. Clinical significance: EIH is an independent predictor of future development of resting hypertension, LVH, and cardiovascular events. It may also indicate residual gradient that only becomes apparent at higher cardiac output. Management: (1) evaluate for re-coarctation (MRI/CT — even a modest resting gradient may become significant during exercise); (2) if no re-coarctation: antihypertensive therapy may be initiated; (3) exercise testing is recommended as part of routine follow-up every 2-3 years in all coarctation patients.

Reference: ESC (2020): ACHD Guidelines