***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background — Patients with repaired coa rct ation are at increased risk of hypertension and cardiovascular disease despite successful repair . We studied the function of conduit arteries in upper and lower limbs of patients late after successful coa rct ation repair and its relation to age at surgery . Methods and Results —Flow-mediated dilatation ( FMD ) and the dilatation after sublingual nitroglycerin ( NTG , 25 & mgr;g ) were measured by using high-resolution ultrasound in the brachial artery in 64 coa rct ation patients ( 44 males and 20 females , aged 19±10 years ; median age at operation 4 months ) and 45 control subjects ( 28 males and 17 females , aged 19±10 years ) and in the posterior tibial artery in 37 patients and 22 control subjects . Arterial stiffness was determined by pulse-wave velocity ( PWV ) of the brachioradial and femoral-dorsalis pedis tracts . Patients , compared with control subjects , had lower brachial FMD ( 7.16±3.4 % versus 8.62±2.3 % , respectively;P = 0.02 ) and NTG ( 11.46±4.3 % versus 13.21±4.6 % , respectively;P = 0.046 ) and higher brachioradial PWV ( 9.17±3.1 versus 8.06±1.9 m/s , respectively;P = 0.05 ) . In contrast , posterior tibial FMD , NTG , and lower limb PWV were comparable . Age ( months ) at the time of repair was related to brachioradial PWV ( r = 0.42 , P = 0.002 ) but not to brachial FMD or NTG . Conclusions — Patients with repaired aortic coa rct ation have impaired conduit artery function , with abnormal responses to flow and NTG , and increased vascular stiffness confined to the upper part of the body . Early repair is associated with preserved elastic properties of conduit arteries , but reduced reactivity remains Introduction : Since the 1980s , stent implantation has evolved as an important therapeutic strategy for coa rct ation of the aorta . However , available data is frequently flawed by short follow‐up , lack of adequate follow‐up imaging , and retrospective nature of data collection . Methods : Data was prospect ively collected using a multicenter registry congenital cardiovascular interventional study consortium ( CCISC ) . Between 2000 and 2009 , 302 patients from 34 centers with a median weight of 58 kg underwent stent implantation for coa rct ation .  Eligible patients ( 44 % ) completed intermediate follow‐up ( 3–18 months ) with integrated imaging ( cath , CT , MRI ) , whereas 21 % completed long‐term follow‐up ( > 18–60 months ) . Procedural success was defined as UL/LL systolic gradient of less than 20 mm Hg , lack of significant recurrent obstruction , and freedom from unplanned repeat intervention . Results : Acute procedural success was 96 % . Cumulative intermediate success was 86 % , and cumulative long‐term success was 77 % . Unplanned repeat interventions were required in 4 % , and aortic wall complications were seen in 1 % of patients ( dissection n = 1 and aneurysm n = 3 ) . Other adverse events ( n = 15 ) occurred mainly acutely and included technical complications such as stent malposition ( n = 9 ) . At long‐term follow‐up , 23 % of patients continued to have systolic blood pressure above the 95th centile , 9 % had an upper‐to‐lower limb blood pressure gradient in excess of 20 mm Hg , and 32 % were taking antihypertensive medication . Conclusions : This study documented acute , intermediate , and long‐term outcome data comparable or superior with other surgical or interventional series . However , even with successful initial stent therapy , patients continue to require long‐term follow‐up and have associated long‐term morbidity , relating to aortic wall complications , systemic hypertension , recurrent obstruction as well as need for repeat intervention . © 2010 Wiley‐Liss , Although reference values for ambulatory blood pressure ( ABP ) monitoring have been investigated in several population studies , these values were derived from cross-sectional observations and were based merely on the statistical distribution of blood pressure values . Therefore , we conducted a prospect i ve cohort study to identify reference values for 24-hour ABP  in relation to prognosis . We obtained measurements of 24-hour ABP  for 1542 subjects ( 565 men ) aged 40 years and over in a general population of a rural Japanese community and then followed-up their survival status . There were 117 deaths during the follow-up period ( mean , 6.2 years ) . The association between baseline 24-hour ABP values and mortality , examined by the Cox proportional hazards regression model adjusted for possible confounding factors , showed a better fit with a second-degree equation than with a first-degree equation . On the basis of the results of this analysis , we identified the following reference values as the optimal blood pressure ranges that predict the best prognosis : 120 to 133 mm Hg for systolic blood pressure and 65 to 78 mm Hg for diastolic blood pressure . 24-Hour ABP values > 134/79 mm Hg and < 119/64 mm Hg were related to increased risks for cardiovascular and noncardiovascular mortality , respectively . This is the first report to propose reference values for  24-hour ABP  based on a prognostic criterion OBJECTIVES The purpose of this study was to evaluate the effect of ramipril on endothelial function and inflammatory process in a group of normotensive subjects with successfully repaired coa rct ation of the aorta ( SCR ) . BACKGROUND Subjects with SCR experience higher long-term cardiovascular risk as a result of the relapse of arterial hypertension or owing to nonreversible structural changes in the pre-coa rct ation arterial tree . These subjects experience endothelial dysfunction in the right forearm and appear to have elevated levels of proatherogenic inflammatory markers , even in the absence of arterial hypertension . METHODS Twenty young individuals age 27.3 + /- 2.4 years old with SCR 13.9 + /- 2.2 years previously , received ramipril 5 mg/day for 4 weeks in a r and omized , cross-over , controlled trial . Endothelial function was evaluated in the right forearm by gauge-strain plethysmography , and serum levels of interleukin (IL)-1b , IL-6 , soluble CD40 lig and ( sCD40L ) , and soluble vascular cell adhesion molecule (sVCAM)-1 were determined by enzyme-linked immunosorbent assay . RESULTS Ramipril improved endothelial function ( p < 0.001 ) and decreased the expression of proinflammatory cytokine IL-6 ( p < 0.05 ) and sCD40L ( p < 0.01 ) . Furthermore , ramipril decreased serum levels of sVCAM-1 ( p < 0.01 ) but failed to affect serum levels of C-reactive protein . These effects were independent of blood pressure lowering . CONCLUSIONS Ramipril reversed the impaired endothelial function and decreased the expression of proinflammatory cytokine IL-6 , sCD40L , and adhesion molecules in normotensive subjects with SCR . These findings imply that ramipril treatment may have antiatherogenic effects in subjects with SCR , even in the absence of arterial hypertension OBJECTIVES This study was design ed to investigate the influence of aortic arch geometry on vascular remodeling after anatomically successful repair of coa rct ation of the aorta ( CoA ) . BACKGROUND Abnormalities of the precoa rct ation vasculature are known to occur after CoA repair and appear related to adverse outcomes . The influence of aortic arch geometry on such abnormalities is unknown . METHODS Sixty-three postcoa rct ectomy subjects ( age 15.9 + /- 6.3 years ) were compared with 63 control volunteers . Aortic arch shape was characterized on magnetic resonance imaging using both qualitative classification , identifying 3 subtypes of arch geometry ( Gothic , Crenel , Romanesque ) , and a quantitative index , height/width ratio ( H/W ) of the aorta . Using ultrasound , we measured carotid artery intima-media thickness ( IMT ) and stiffness index and distensibility , as well as right brachial artery flow-mediated dilation ( FMD ) and glyceryl trinitate (GTN)-induced dilatation , to assess the precoa rct ation vasculature of these subjects . RESULTS Gothic arch type was associated with higher carotid IMT and stiffness index , lower carotid distensibility ( p < 0.001 for all ) , and lower brachial reactivity ( FMD , p < 0.01 ; GTN response , p < 0.001 ) compared with Crenel and Romanesque geometries and with control subjects . The height/width ratio was also significantly related to these vascular abnormalities . Even in CoA subjects with Romanesque arch geometry , arterial function and stiffness parameters were significantly impaired compared with control subjects . CONCLUSIONS In young adult survivors of anatomically successful CoA repair , a gothic-type aortic arch with high H/W is associated with abnormal IMT , higher aortic stiffness index , and impaired arterial reactivity in the pre-CoA vasculature Chronic hypertension is a major concern in adults who have undergone resection of coa rct ation of the aorta ( CoA ) in childhood . In otherwise healthy subjects , exercise-induced hypertension is prognostic for chronic hypertension ; however , the prognostic value in patients with CoA remains unknown . The aim of the present study was to evaluate the predictive value of exercise-induced hypertension for chronic hypertension in these patients . In the present prospect i ve follow-up study , 74 patients with CoA ( 58 % men , age 30.9 ± 9.5 years ) underwent  ambulatory blood pressure ( BP ) monitoring and exercise testing twice  from 2001 to 2009 with a follow-up period of 6.3 ± 0.8 years . Hypertension was defined as a mean systolic BP ≥140 mm Hg and /or mean diastolic BP ≥90 mm Hg or the need for antihypertensive treatment . Exercise-induced hypertension was defined as a mean systolic BP of < 140 mm Hg and peak exercise systolic BP of ≥200 mm Hg . At baseline , 27 patients ( 36 % ) were hypertensive , 11 ( 15 % ) had exercise-induced hypertension , and 36 ( 49 % ) were normotensive . At follow-up , all 27 hypertensive patients remained hypertensive . Of the 11 with exercise-induced hypertension , 7 ( 64 % ) had developed chronic hypertension , and 4 ( 36 % ) continued to have exercise-induced hypertension . Of the 36 normotensive patients , 7 ( 19 % ) had developed hypertension , 12 ( 33 % ) had developed exercise-induced hypertension , and 17 ( 47 % ) remained normotensive . On multivariate analysis , baseline maximum exercise systolic BP was independently associated with the mean systolic BP at follow-up ( β = 0.13 , p = 0.005 ) . In conclusion , the maximum exercise systolic BP was a predictor for chronic hypertension in patients with CoA. These findings demonstrate the clinical importance of exercise-induced hypertension and warrant additional study into the long-term consequences of exercise-induced hypertension and the potential beneficial role of early antihypertensive treatment in adult patients after CoA repair with  exercise-induced hypertension Even after successful repair , hypertension is one of the main determinants of cardiovascular morbidity and mortality in patients with aortic coa rct ation ( CoA ) . We compared the effect of c and esartan ( angiotensin II receptor blockade ) and metoprolol ( beta-adrenergic receptor blockade ) on blood pressure , large artery stiffness , and neurohormonal status in hypertensive patients after repair of CoA. In the present open-label , crossover study , hypertensive patients after CoA repair were first r and omly assigned to treatment with c and esartan 8 mg or metoprolol 100 mg once per day . After 8 weeks of treatment with one of the drugs , the other treatment was given for 8 weeks . The treatment effects were assessed with 24-hour ambulatory blood pressure monitoring , measurement of large artery stiffness , and neurohormonal plasma levels at baseline and after 8 weeks of either treatment . Sixteen patients ( mean age 37 + /- 12 years , 26 + /- 15 years after repair , 63 % men ) completed the study . The 24-hour mean arterial pressure at baseline was 97.7 + /- 6.2 mm Hg . Metoprolol ( mean dose 163 + /- 50 mg/day ) decreased the mean arterial pressure ( 7.0 + /- 4.2 and 4.1 + /- 3.6 mm Hg , respectively ) more than did c and esartan ( mean dose 13 + / 
    Output:
    
Hypertension remains a common complication following aortic coa rct ation repair .