Epidemiology of hypertensive retinopathy in young patients after coarctation of the aorta repair

Purpose
Coarctation of the aorta is a cause of childhood hypertension. In some patients hypertension persists after coarctation repair. We evaluated hypertensive retinopathy in patients after coarctation repair, factors correlated with retinopathy, specificity of retinal findings.

Material and methods
54 patients (mean age of surgery 6 years, mean follow-up time 10 years), were studied. Hypertension was present in all subjects prior to operation. We used ambulatory blood pressure monitoring (ABPM) to follow blood pressure evaluation after repair. Direct ophtalmoscopy was performed in all subjects.

Results
Subjects were divided into two groups according to current blood pressure values: group I – normotensive – 34 pts, group II – hypertensive – 20 pts. Hypertensive angiopathy (I-II K-W) was found in 30% patients (9% in group I and 65% in group II). Subjects with angiopathy were mean 7 years older and had higher blood pressure values (24h mean systolic and load), than those without retinal changes. Patients with and without angiopathy did not differ significantly in preoperative blood pressure values. 81% subjects with angiopathy were hypertensive and 86% patients without retinal changes were normotensive. The most common fundus pathologies were arteriolar tortuosity (35%) and narrowing (28%).

Conclusions
1. There were no signs of persistent angiopathy in most normotensive patients, even though all of them suffered from hypertension in childhood. 2. In our study hypertensive angiopathy corresponded with present blood pressure values and patient's age. 3. All abnormalities were mild (I-II degree K-W), which also caused some diagnostic difficulties to distinguish between normal and pathological subjects.