title: Measurement of leg blood pressure: the most straightforward way to the diagnosis.
abstract: 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.
authors.affiliation: Department of Medicine, Division of General Internal Medicine, Nijmegen, the Netherlands. R.Gilles@nucmed.umcn.nl
authors.forename: R
authors.initials: R
authors.lastname: Gilles
authors.forename: B A J
authors.initials: BA
authors.lastname: Veldman
authors.forename: W R M
authors.initials: WR
authors.lastname: Aengevaeren
authors.forename: L J
authors.initials: LJ
authors.lastname: Schultze-Kool
authors.forename: A
authors.initials: A
authors.lastname: van Oort
authors.forename: J W M
authors.initials: JW
authors.lastname: Lenders
mesh_terms: D000328:Adult; D001017:Aortic Coarctation / Q000175:diagnosis*; D001795:Blood Pressure Determination / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000209:etiology; D007866:Leg / Q000098:blood supply*; D008297:Male