Worsening Hypertensive Control as a Clue to High-Grade Brachiocephalic and Subclavian Artery Stenosis in Primary Care: A Case Report

Objective: Unusual clinical course Background:Upper-extremity peripheral arterial disease (PAD) is a less common manifestation of peripheral arterial disease than lower-extremity PAD.Many patients with upper-extremity PAD remain asymptomatic until significant arterial stenosis develops, leading to the manifestation of limb ischemia.Measuring bilateral arm blood pressure can detect an inter-arm blood pressure difference and lead to early diagnosis and management.This report describes the case of a 67-year-old man who presented with uncontrolled hypertension and was found to have unequal upper-limb blood pressure measurements due to high-grade brachiocephalic and subclavian artery stenosis. Case Report:We present the case of a 67-year-old man who attended a primary care clinic for hypertension follow-up.He experienced worsening of his previously controlled hypertension over 3 months, without claudication or neurological symptoms.Physical examination identified a significant inter-arm blood pressure discrepancy and diminished pulses in the affected limb.Computed tomography angiography confirmed high-grade stenosis over the right brachiocephalic artery and subclavian artery.He was subsequently referred to the vascular team and managed with medical therapy and regular surveillance.At 1-year follow-up, he remained asymptomatic with no reported complications. Conclusions:This case highlights the importance of considering upper-extremity PAD in patients with uncontrolled hypertension detected during a routine primary care follow-up.Early diagnosis and optimal medical therapy are crucial for achieving favorable outcomes and preventing complications by reducing cardiovascular risk.