C84. Resistent Hypertension in Young Patient, what has Been Missed? A Case Report of Coartation of the Aorta

In children and adolescent patient the most common cause hypertension is secondary due to renal disease. There are other cause of secondary hypertension including Coartation of the Aorta (CoA). Early diagnosis and prompt treatment are important for CoA, if left untreated CoA can causes ventricular hypertrophy, premature coronary artery disease and eventually heart failure.

A 17 Years old patient with history of hypertension since the age of 12. He was suspected secondary hypertension due to renal disease and referred to pediatric nephrologist. Laboratory examination and CT angiography renal artery showed normal result. He was treated with multiple antihypertensive drugs, but remains hypertensive despite of medical therapy for 5 years.

He was referred to our hospital due to resistant hypertension. At physical examination this patient revealed blood pressure at upper 150/90 and lower extremities 100/60. Echocardiography examination and CT angiography showed Left Ventricle Hypertrophic (LVH) with coartation aorta located distal to left subclavian artery. Thoracic Endovascular Repair (TEVAR) was performed to dilated the coartation in this patient. Post TEVAR procedure peak systolic gradient reduced from 51 mmHg to 4 mmHg.

CoA are one of the causes of secondary hypertension. Uncommonly resistant hypertension can occur in CoA. Early diagnosis and prompt treatment are important for CoA. In this patient the CoA already caused LVH, and if left untreated it can lead more severe complication such as heart failure, and premature coronary artery disease and death.