Two adult patients with presumed primary hypertension are presented. In the first patient the diagnosis of coarctation of the aorta was straightforward while in the second patient there was a substantial delay in reaching the correct diagnosis.
A 32-year-old patient was analysed for hypertension in
the outpatient clinic. At physical examination a systolic
cardiac murmur was present and leg blood pressure
was not measurable. Magnetic resonance imaging
angiography showed a severe coarctation of the thoracic
aorta with extensive distended collateral blood vessels.
A second patient was a 31-year-old man referred with
longstanding hypertension and an unsatisfactory blood
pressure response to treatment. Previously, a diagnosis
of primary hypertension was made. Renal computed
tomography angiography excluded renal artery stenosis
as a cause of hypertension but disclosed many distended
collateral blood vessels in the musculus rectus abdominis
and in the upper abdominal area. Leg blood pressure was measured and further analysis revealed a coarctation of the aorta.
Both patients illustrate and emphasise the importance of
leg blood pressure measurement at a first analysis of adult hypertensive patients and should always be performed when hypertension is accompanied by murmurs or weak femoral pulsations.