Case of a Young Man with Abnormally High BP

A 30-year-old male had a very high blood pressure (BP) of 234/144 mmHg and was referred to the ER. He had an active smoking history. Physical examination in the ER showed a BP of 221/125 mmHg and a heart rate (HR) of 50 beats/minute. A routine electrocardiogram (EKG) was carried out, and the image is provided for your reference. He had no palpitation, chest pain, dizziness, dyspnea, or syncope.

Antihypertensive medication for BP was administered, and the patient was moved to the cardiology ward. Arterial pulses were found to be absent, and radial pulse was found to be very weak. BP in the right upper limb was 126/86 mmHg, in the right lower limb was 85/54 mmHg, in the left upper limb was 145/85 mmHg and in the left lower limb was 75/50 mmHg. Mild renal impairment was detected in his initial blood work. CT thoracic aortogram was normal, and CT coronary angiogram did not detect any…