Aortic dissection in young patients with chronic hypertension

We describe four patients aged 14 to 21 years who developed acute aortic di ssection, In three of the four patients, the course was fatal, despite aggr essive medical and surgical intervention. All four patients had sustained s ystemic hypertension related to chronic renal insufficiency. The patients h ad no other identifiable risk factors for aortic dissection, including cong enital cardiovascular disease, advanced atherosclerosis, vasculitis, trauma , pregnancy, or family history of aortic dissection. Although aortic dissec tion is rare in individuals younger than 40 years of age, young patients wi th sustained systemic hypertension are at increased risk for this serious a nd often fatal condition. Physicians must be aware of this rare complicatio n of hypertension and consider aortic dissection in the differential diagno sis of unusual chest, abdominal, and back pain in hypertensive children, ad olescents, and young adults. (C) 1999 by the National Kidney Foundation, In c.