What is the medical treatment for hypertension in a late presentation of coarctation of the aorta (CoA)?

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Preoperative hypertension can be effectively treated using beta-blockers. The goal should be to reduce upper extremity hypertension, but remember that vigorous attempts to achieve normal upper extremity blood pressure (BP) may result in inadequate lower-body perfusion. Beta-blocker therapy prior to surgery may reduce the severity of postoperative hypertension, although most patients with preoperative hypertension require at least transient postoperative therapy. Remember that relieving the aortic obstruction promptly rather that attempting to treat hypertension with antihypertensive medications is better. [1]

Postoperative hypertension can be treated short-term with vasodilators, such as sodium nitroprusside, and intravenous beta-blockers, such as esmolol. When longer-term antihypertensive therapy is required, beta-blockers may be continued, and if no residual arch obstruction exists, ACE inhibitors or angiotensin II antagonists (pediatric dosing not established for angiotensin II antagonists) may be added if hypertension persists despite beta-blocker therapy.

Guidelines regarding beta-adrenergic receptor blockers have been established. [39]

One study concluded that data is not sufficient to discourage or recommend the use of beta-blockers in children with CHF. [40]


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