Correspondence

A Medical Mystery: High Blood Pressure — The Answer

N Engl J Med 2007; 357:717-718August 16, 2007

Article

The medical mystery in the June 21 issue1 involved a 28-year-old woman with a 1-year history of high blood pressure that was diagnosed during her first pregnancy. In addition to an elevated blood pressure, at 200/100 mm Hg, in the left arm, physical examination revealed a grade 3/6 midsystolic murmur over the anterior part of the chest and back. Radiography of the chest showed classic changes associated with coarctation of the aorta, including notching of the ribs (Figure 1AFigure 1Coarctation of the Aorta in a Young Woman., arrows) due to erosion by dilated collateral vessels and ectasia of the ascending aorta. Magnetic resonance imaging showed constriction of the lumen of the aorta distal to the origin of the left subclavian artery (Figure 1B, arrow). After endovascular repair with stent placement (Figure 1C, arrow), the patient's blood pressure normalized. After 1 year of follow-up, she continued to do well, with a blood pressure of 136/87 mm Hg while she was taking 10 mg of amlodipine daily.