title: [Hypertension due to aortic coarctation--a missed clinical diagnosis].
abstract: METHODS
  A 30-year-old woman presented to our emergency department with severe headaches, dizziness and uncontrolled hypertension. She had arterial hypertension and a known heart murmur since adolescence. Previous medical work up did not reveal any cause for secondary hypertension. Recently her blood pressure had been difficult to control. A systolic murmur as well as absent inguinal and feet pulses were notable at the physical examination.
  
  
  METHODS
  When performing doppler ultrasound the closing pressures of the dorsalis pedis arteries were only 70 mm Hg compared to a blood pressure reading of 160 mm Hg on the upper arms. Thoracic magnetic resonance imaging showed subtotal aortic coarctation causing the differences in blood pressures. Echocardiography and cardiac catheterization additionally revealed a moderately stenosed bicuspid aortic valve, the pressure gradient across the coarctation was 30 mm Hg.
  
  
  RESULTS
  Despite the severity of the coarctation an interventional approach was favoured instead of a classical operative therapy. Balloon dilatation with stent implantation was performed without complications. Since the intervention blood pressure have remained normotensive, the coarctation gradient being markedly reduced.
  
  
  CONCLUSIONS
  In young patients with arterial hypertension, as well as in cases of severe and refractory hypertension, causes of secondary hypertension must be looked for and excluded. Especially when hypertension occurs in adolescence, aortic coarctation should be taken into account, in addition to renal or endocrine causes. A thorough physical examination with cardiac auscultation and checking of all peripheral pulses is the crucial step to the diagnosis.
authors.affiliation: Zentrum für Innere Medizin IV, Abteilung für Allgemeine Innere Medizin und Nephrologie, Robert-Bosch Krankenhaus, Stuttgart. Markus.Bolzhauser@rbk.de
authors.forename: M
authors.initials: M
authors.lastname: Bolzhauser
authors.forename: N
authors.initials: N
authors.lastname: Braun
authors.forename: M D
authors.initials: MD
authors.lastname: Alscher
authors.forename: M
authors.initials: M
authors.lastname: Kimmel
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon; D055109:Ankle Brachial Index; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001017:Aortic Coarctation / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D003097:Collateral Circulation / Q000502:physiology; D003131:Combined Modality Therapy; D003951:Diagnostic Errors; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D020343:Hypertensive Encephalopathy / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D010343:Patient Admission; D015607:Stents; D018608:Ultrasonography, Doppler
chemical_list: D000959:Antihypertensive Agents