# A case of a young man with secondary hypertension

## TL;DR

A young man with high blood pressure was diagnosed with a rare heart condition and successfully treated with surgery.

## Contribution

This case highlights the importance of checking blood pressure in all limbs to detect coarctation of the aorta.

## Key findings

- The patient had reduced pulses in the lower limbs and a significant blood pressure difference, indicating coarctation of the aorta.
- Computed tomography confirmed severe coarctation distal to the left subclavian artery.
- The patient was successfully treated with coarctoplasty and stenting.

## Abstract

Secondary hypertension is characterized by an elevated blood pressure greater than 140/90 mmHg, which occurs as a consequence of other diseases. The common etiologies of secondary hypertension include renal parenchymal causes, endocrine disorders, and vascular pathologies like coarctation of the aorta (CoA).

A 20-year-old patient was admitted to our hospital as he complained of headache and palpitations since one week. On examination, the blood pressure in his right upper limb was 180/100 mmHg. The volume of the femoral and the dorsalis pedis pulses was found to be reduced bilaterally. The patient was started on antihypertensive medication labetalol 10 mg injection intravenously immediately. After clinical suspicion and a series of investigations, the patient was diagnosed with severe CoA, distal to the origin of the left subclavian artery via computed tomography (CT) aortogram. The patient was managed by coarctoplasty with stenting.

The most striking examination findings indicative of CoA include decreased lower limb pulses and a blood pressure difference of >20 mmHg across both the lower and upper extremities. It is important to evaluate the blood pressure in both upper and lower limbs to diagnose obstructive vascular diseases.

The presence of multiple well-developed collaterals can often mask symptoms and delay the detection of hypertension in patients with CoA. Patients with CoA require regular follow-up to monitor left ventricular outflow tract obstruction, and patients with severe CoA should be treated interventionally to prevent complications including aortic aneurysm and dissection.

The patient was managed by coarctoplasty with stenting and recovered well post-surgery.