Why do children develop hypertension after coarctation repair?

Hypertension is common in patients with repaired coarctation and variance in blood pressure explains the majority of cardiovascular risk in this population. It was commonly thought that hypertension resulted from delayed repair typical of previous surgical eras.

However, despite definitive neonatal repair a significant proportion of children still develop hypertension in the absence of persistent arch obstruction.

By adulthood these patients have increased aortic stiffness, abnormal haemodynamics, and often difficult to treat hypertension.

Unfortunately, the causes of hypertension, and the reasons for onset in childhood are unclear, and this hampers rational treatment to reduce lifetime cardiovascular risk.

Using pilot data, I have identified a plausible relationship between abnormalities of early life renal physiology and elevated blood pressure in patients with coarctation. In this fellowship I seek to understand the mechanisms which initiate and sustain abnormal blood pressure.

I have designed synergistic studies which aim to address how abnormalities in infant renal function, salt-sensitivity and abnormal autonomic and neurohumoral function influence childhood blood pressure.

The scientific knowledge arising from this fellowship will enable the development of evidence-based treatments to prevent long-term cardiovascular complications of coarctation and save lives.