ABNORMAL INTER-ARM SYATOLIC BLOOD PRESSURE DIFFERENCE IN ADULTS WITH CONGENITAL HEART DISEASE

Abstract

Objective: Many papers have been reported that hypertension and cardiovascular disease are high frequency in adults with congenital heart disease. It is well known that significant inter-arm blood pressure difference can predict cardiovascular risk. We investigate the inter-arm blood pressure difference in adults with congenital heart disease. Design and method: We enrolled 100 consecutive subjects aged 20 years or more, who visited the Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center. The exclusion criteria were history of arrhythmia, which makes accurate pulse wave analysis impossible and history of cardiac operation within 6 months. The patients were classified into 3 groups. The patients in group A had undergone surgery, which sacrifice subclavian arteries (subclavian flap method and original Blalock-Taussig shunt). The patients in group B had undergone surgery to their subclavian arteries, which conserve their subclavian arteries (modified Blalock- Taussig shunt). The patients in group C had not undergone surgery to their subclavian arteries. The bilateral brachial blood pressures were simultaneously measured using form PWV/ABI (Colin, Komaki, Japan). The inter-arm systolic blood pressure difference greater than 10mmHg was defined as significant inter-arm systolic blood pressure difference. Results: Patients’ age was 36.6±14.9 years. Mean difference between bilateral brachial systolic blood pressures was 8.2±13.6 mmHg. Twenty-one patients demonstrated the inter-arm systolic blood pressure difference (29%). Nine patients were classified as group A and all patients in group A demonstrated inter-arm systolic blood pressure difference (29.1±35.6mmHg). Sixteen patients were classified as group B and 9 patients had undergone modified Blalock-Taussig shunt bilaterally. Four patients (44%) in group B demonstrated inter-arm systolic blood pressure difference (bilateral; 3, unilateral: 1). In 75 group C patients, 8 patients (11%) demonstrated inter-arm systolic blood pressure difference. There was no difference between group C patients in with and without the inter-arm systolic blood pressure difference in body mass index, hemoglobin A1 level, lipid profile. Conclusions: The significant inter-arm systolic blood pressure difference in adults with congenital heart disease is not uncommon. The intervention can strongly influence on their inter-arm systolic blood pressure difference.