L'index de pression systolique dans un premier bilan d'hypertension : outil diagnostique de choix de la coarctation aortique. Un cas rapporté

A 24-year-old African who had been living in France for few years first consulted at our institution for severe systemic hypertension. He had no prior medical or surgical history. The patient was strictly asymptomatic. Except for systemic hypertension at both arms, the basic physical examination was normal with no cardiac murmur and no pulse deficit. A 24-hour ambulatory blood pressure monitoring performed before the consultation confirmed the presence of systemic hypertension with a mean blood pressure at 155/90 mmHg during the day and also during the night under anti-hypertensive treatment. Ankle-brachial index measurement was low at 0.8 at both legs. Subsequently, a trans-thoracic echocardiography (TTE) and an aortic CT-scanner were performed. The TTE did not find any abnormalities including no aortic dilatation or no ventricular hypertrophy. The CT-scanner revealed a partial aortic coarctation. The patient underwent aortic surgery and recovered in few days with quite normal blood pressure under medical treatment. In conclusion, systematic ankle-brachial index is useful and recommended in every patient at first visit for systemic hypertension. Its safety and simplicity make it an essential tool in the management of systemic hypertension especially in populations with no systematic screening of aortic coarctation in childhood. It was in the present case very useful for the final diagnosis and treatment. In addition, it is an efficient tool to screen patients with asymptomatic peripheral artery disease and it can help for stratification of cardiovascular risk.