Issue: 2008 > February > case report

Measurement of leg blood pressure: the most straightforward way to the diagnosis

R. Gilles, B.A.J. Veldman, W.R.M. Aengevaeren, L.J. Schultze-Kool, A. van Oort, J.W.M. Lenders


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.