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Vol. 30. Issue. 1.January 2010
Pages 1-142
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Aortic coarctation as a rare cause of hypertension in the elderly
Coartación aórtica como causa poco frecuente de hipertensión arterial en el anciano
S.. Álvarez Tundidora, Carlos Ruiz-Zorrilla Lópeza, B.. Gómez Giraldaa, A.. Molinaa
a Servicio de Nefrología, Hospital Universitario Río Hortega, Valladolid, España,
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Dear Editor,

Hypertension in the elderly is mainly essential with coarctation of the aorta a secondary cause.1 The median survival of patients with coarctation of the aorta is low: only 25% live past 50 years of age.2,3 Most cases are women, due to a lower tendency to develop atherosclerosis and hypertension.4

Below is the case of a male patient aged 83 who was admitted for surgery of the left paranasal squamous cell carcinoma, which appeared as a complication in a compressive cervical haematoma that required urgent tracheotomy. His background revealed longstanding refractory hypertension. A physical examination revealed a normal cardiopulmonary auscultation with distal pulses present on the upper limbs and diminished in the lower. Blood pressure in the upper right extremity was 182/81mmHg, significantly higher than the left side, where it was 130/75mmHg. The latter was similar to those of the  lower extremities. Analytically, the data showed no renal secondary hypertension, thyroid or kidney disease. The echocardiogram revealed a significant hypertrophy of the left ventricle in septal location. A slight cardiomegaly and the inverted E sign (Figure 1) were observed on the radiograph which, together with the difference in blood pressure in both upper  extremities, directed us towards a diagnosis of probable aortic coarctation.

Therefore, a chest CT was performed with contrast. This revealed, in the aortic arch, distal to the supra-aortic trunks, a poststenotic dilatation of a maximum of 3.7cm in diameter, compatible with aortic coarctation (Figure 2).

After assessing the clinical status, the tumour staging (T2, N2b, M0) and the high comorbidity of surgery, conservative treatment was chosen.

In conclusion, the diagnosis of aortic coarctation should always be discarded for any patient with refractory hypertension. A proper physical examination with palpation of distal pulses and measurement of blood pressure control between extremities is a good guide towards diagnosis.

Figure 1.

Figure 2.

Convens C, Vermeersch P, Paelinck B, Van den Heuvel P, Van den Branden F. Aortic coarctation: A rare unespected cause of secondary arterial hypertension in the ederly. Catheterization and Cardiovascular Diagnosis 1996;39:71-4. [Pubmed]
Miro O, Jiménez S, González J, et al. Highly effective compensatory mechanisms in a 76- year-old man with a coarctation of the aorta. Cardiology 1999;92:284-6. [Pubmed]
Therrien J, Gatzoulis M, Grahan T, et al. Canadian Cardiovascular Society Consensus Conference 2001 up date: recommendations for the management of adults with congenital heart disease: part II. Can J Cardiol 2001;17:1029-50. [Pubmed]
Perloff JK. Coarctation of the aorta. Philadelphia: WB. Saunders, 1987;125-60.
Nefrología (English Edition)
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