The patient gives no history of cardiac symptoms, typical of individuals with systemic hypertension, and has no knowledge of hypertension (HTN) in family members. The initial finding of systemic hypertension requires measurement of blood pressure in both arms and legs. This demonstrates systemic hypertension with blood pressure and pulse amplitude in the arms substantially greater than that in the legs. In a young, healthy, asymptomatic individual, this almost assuredly establishes the presence of aortic coarctation. An aortic ejection sound at the upper right sternal edge indicates the presence of a bicuspid aortic valve, found in most patients with aortic coarctation. A short, low intensity systolic murmur at the upper right sternal edge indicates little or no aortic valve stenosis. A single second heart sound at the upper left sternal edge occurs because A2 is delayed by increased left ventricular afterload. An early, high frequency diastolic murmur indicates aortic regurgitation. Our patient's blood pressures in both arms and legs are significantly higher than usual for a patient with aortic coarctation, suggesting that his hypertension is complex and that hypertension may persist following correction of the anatomic obstruction.