Two weeks ago, Ngoc experienced headaches and dizziness, with home blood pressure often ranging from 140-150 mmHg, sometimes reaching 155 mmHg. She also frequently felt leg pain while walking, which subsided with rest.

According to Dr. Nguyen Thu Trang, Deputy Head of the Cardiology Department at Tam Anh Cau Giay General Clinic, Ngoc’s hypertension and accompanying symptoms suggested a potential underlying cause.

Ultrasound revealed severe aortic coarctation, with a pressure gradient of approximately 33 mmHg across the narrowed segment. Computed tomography (CT) angiography showed the aortic isthmus was narrowed and tortuous (type IV), located immediately after the origin of the left subclavian artery. This condition reduces blood supply to the lower half of the body, causing hypertension and leg fatigue during walking, according to Dr. Trang.

Technicians perform computed tomography to survey the extent and location of the patient's aortic narrowing. *Tam Anh General Hospital*

Aortic coarctation can occur at various ages, mostly detected in infancy or childhood. In some individuals, however, collateral circulation (accessory blood vessels) develops, compensating for the blood deficit, allowing the condition to progress silently for many years, according to Dr. Trang. Patients may experience headaches, dizziness, lightheadedness, or even syncope due to hypertension in the upper body, while the lower body suffers from reduced blood supply. Many cases are only discovered after heart failure or other complications have developed.

In Ngoc's case, the condition was detected as soon as symptoms appeared, before causing target organ damage or complications.

After consultation, doctors performed balloon angioplasty and stent placement at the narrowed site to restore blood flow. Post-intervention, the pressure gradient across the narrowed segment decreased. Ventricular function was normal, with no complications such as aortic dissection or pericardial effusion.

Ngoc recovered well, her blood pressure stabilized, and she was discharged after two days. She continues to take medication as prescribed and undergoes regular check-ups.

The intervention team performed balloon angioplasty and stent placement at the narrowed site, restoring normal blood flow for the patient. *Tam Anh General Hospital*

According to Dr. Trang, most people with hypertension fall into the category of primary (essential) hypertension, meaning no specific cause is identified, requiring long-term control with medication and lifestyle changes. However, a small number have secondary hypertension due to underlying conditions such as kidney disease, endocrine disorders, or heart and blood vessel abnormalities.

Hypertension in individuals under 40, especially when hard to control with medication or accompanied by unusual symptoms, requires investigation to find the cause. If the correct cause is identified and treated, patients may be able to manage their hypertension without medication.

Ly Nguyen

*Patient's name has been changed