skip to main content

Post-coarctation Repair Hypertension — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCongenital Heart Disease (Adult)Post-coarctation Repair HypertensionEECC

A 30-year-old man with repaired coarctation of the aorta at age 5 presents with hypertension. His resting arm BP is 160/95 mmHg bilaterally (no gradient between arms). MRI aorta shows no re-coarctation. Why is hypertension common after coarctation repair?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Persistent hypertension after coarctation repair affects 30-60% of patients despite successful repair — mechanisms include residual aortic arch abnormalities, increased aortic stiffness, baroreceptor resetting, RAAS activation, and endothelial dysfunction from pre-repair haemodynamic exposure

Hypertension is the most common long-term complication after coarctation repair, affecting 30-60% of patients even with no residual gradient. Mechanisms: (1) aortic wall abnormalities — increased stiffness, reduced compliance (the pre-coarctation aorta undergoes structural remodelling); (2) residual arch hypoplasia (diffuse narrowing not correctable by focal repair); (3) baroreceptor dysfunction (chronic pre-repair hypertension resets baroreceptor thresholds); (4) RAAS activation (persistent despite correction of renal hypoperfusion); (5) endothelial dysfunction. The 2020 ESC ACHD Guidelines recommend: lifelong BP monitoring, ABPM (for masked hypertension), aortic imaging (for re-coarctation and aneurysm formation at repair site), and standard antihypertensive therapy. Exercise testing may reveal exaggerated hypertensive response.

Reference: ESC (2020): ACHD Guidelines