TY - JOUR T1 - Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children. AU - Roeleveld,Peter P, AU - Zwijsen,Eline G, PY - 2017/5/19/entrez PY - 2017/5/19/pubmed PY - 2017/9/30/medline KW - child KW - coarctation of the aorta KW - paradoxical hypertension KW - review KW - survey KW - treatment SP - 321 EP - 331 JF - World journal for pediatric & congenital heart surgery JO - World J Pediatr Congenit Heart Surg VL - 8 IS - 3 N2 - BACKGROUND: Paradoxical hypertension after repair of coarctation of the aorta is a well-known phenomenon. The pathogenesis involves the activation of the sympathetic nervous system (first phase) and renin-angiotensin system (second phase). Only a limited number of different treatment strategies have been published in the literature, without any comparative studies. METHODS: Our aim was to describe the current international practice variation surrounding pharmacological treatment currently being employed to treat paradoxical hypertension following the repair of coarctation of the aorta in children. We performed an online survey among 197 members of the Pediatric Cardiac Intensive Care Society. We also conducted a systematic review of the literature regarding the treatment of paradoxical hypertension. RESULTS: Eighty-eight people (45%), from 62 different centers, responded and answered the questions regarding blood pressure control. Nitroprusside is the first drug of choice for initial blood pressure control in 66% of respondents, esmolol in 11%, labetalol in 11%, and angiotensin-converting enzyme inhibitors (ACEIs) are used by 3% of respondents. For oral blood pressure control after discharge from the pediatric intensive care unit, 75% of respondents use ACEIs, 18% use labetalol, and 12% use other beta-blockers (propranolol, carvedilol, atenolol, metoprolol). The systematic review identified 14 articles reporting pharmacological treatment of direct postoperative hypertension following coarctation repair. CONCLUSION: There is wide practice variability, due to the lack of sufficient compelling evidence. The majority (66%) of caregivers use nitroprusside to control blood pressure in the acute postoperative phase. The ACEIs are the drug of choice for chronic blood pressure control. SN - 2150-136X UR - https://www.unboundmedicine.com/medline/citation/28520538/Treatment_Strategies_for_Paradoxical_Hypertension_Following_Surgical_Correction_of_Coarctation_of_the_Aorta_in_Children_ L2 - https://journals.sagepub.com/doi/10.1177/2150135117690104?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -