Atenolol vs enalapril in young hypertensive patients after successful repair of aortic coarctation

Late arterial hypertension has been identified as a major predictor for morbidity and mortality in aortic coarctation (aoc) patients. few data are available about efficacy and tolerability of angiotensin converting enzyme inhibitors vs beta-blockers in young aoc patients. this study aimed to evaluate the tolerability and efficacy on 24-h blood pressure (bp) and left ventricular mass/height2.7 (lvmi), of atenolol vs enalapril. we enrolled consecutive aoc hypertensive patients with (a) no history of bp treatment or after >48 h of withdrawn, (b) aged 6–20 years, (c) body mass index (bmi) <90th percentile for age and sex, (d) >12 months from a successful aoc repair and (e) no major associated cardiovascular abnormalities. all patient were evaluated with 24-h ambulatory bp monitoring, standard echocardiography, strain–strain rate imaging, at enrolment, 3, 6 and 12 months of treatment. we studied 51 aoc patients (13±3.9 years, bmi: 21.4±4.3 kg m–2). patients were randomly assigned at atenolol treatment (n=26), or enalapril treatment (n=25). the mean follow-up duration was 11±2 months. both drugs were able to significantly reduce 24-systolic bp (sbp; atenolol: 133±11 mm hg vs 124±16 mm hg, p=0.016; enalapril: 135±6 mm hg vs 127±7 mm hg, p=0.001). only enalapril was able to significantly reduce lvmi (47±12 vs 39.6±10 g m–2.7, p=0.016). only in atenolol group in two cases (7.7%) drug withdrawal was needed because of adverse events. enalapril and atenolol are similarly effective in reducing sbp. however, only enalapril demonstrated a significant reduction of lvmi. in no case, enalapril was stopped because of adverse events.