Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.573433
Title: Coarctation of the aorta and hypertension : a prospective longitudinal cohort evaluation of autonomic and vascular influences on blood pressure control
Author: Kenny, Damien Patrick
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2012
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Abstract:
Coarctation of the aorta (CoA) is associated with long-term morbidity even after early and effective surgical correction. Significant abnormalities in blood pressure control occur which have been linked to adaptive changes in uterine or early neonatal life. Proposed mechanisms include reduced baroreceptor reflex sensitivity, resetting of the renin-angiotensin system and impaired vascular properties. In essential hypertension increased vascular stiffness reduces baroreceptor reflex sensitivity to changes in arterial pressure. However there are no studies of this relationship in patients with CoA. This thesis describes a prospective evaluation of three age groups of children and adolescents with CoA, compared with healthy age-related controls. Non-invasive measurements of autonomic function and arterial stiffness are taken to determine if both are abnormal in patients with CoA and whether there is a progression in these variables linked to the development of arterial hypertension. The main findings of the thesis are: 1. Normalisation of neonatal abnormalities in baroreceptor sensitivity in CoA patients by young childhood. 2. Increased arterial stiffness and systolic blood pressure in young children undergoing subclavian flap repair compared to end-to-end anastomosis. 3. Potential compensation of the arterial baroreceptor for increases in arterial compliance in older children and adolescents with CoA to maintain normal blood pressure. Contrary to the initial hypothesis, it is likely that the interaction between autonomic development, arterial stiffness and blood pressure regulation in patients with repaired coarctation is complex and unlikely to represent a simple progressive maladaptive process where abnormalities in vascular function lead to proportional changes in autonomic control or vice versa. Other factors including abnormal flow patterns in the repaired aorta may be implicated. Future goals include defining if there exists a critical point at which hypertension becomes manifest and determining whether targeted prophylactic therapies may delay or avert changes in the arterial tree that lead to hypertension.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.573433  DOI: Not available
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