COR LOE Recommendations Diagnostic I B-NR Initial and follow-up aortic imaging using CMR or CTA is recommended in adults with coarctation of the aorta, including those who have had surgical or catheter I C-EO Resting blood pressure should be measured in upper and lower extremities in all adults with coarctation of the aorta. Diagnostic (Continued) IIa C-LD Ambulatory blood pressure monitoring in adults with coarctation of the aorta can be useful for diagnosis and management of IIb B-NR Screening for intracranial aneurysms by magnetic resonance angiography or CTA may be reasonable in adults with coarctation of the aorta.S4.2.6-5,S4.2.6-6 IIb C-LD Exercise testing to evaluate for exercise- induced hypertension may be reasonable in adults with coarctation of the aorta who Therapeutic I B-NR Surgical repair or catheter-based stenting is recommended for adults with hypertension and significant native or recurrent coarctation of the aorta.S4.2.6-1,S4.2.6-2,S4.2.6-8 S4.2.6-12 I C-EO GDMT is recommended for treatment of hypertension in patients with coarctation of IIb B-NR Balloon angioplasty for adults with native and recurrent coarctation of the aorta may be considered if stent placement is not feasible and surgical intervention is not an option.S4.2.6-14 Synopsis CoA typically occurs near the ductal remnant and left subclavian artery. Hypertension is the most common se- quela of CoA, whether repaired or unrepaired. BAV is commonly associated with CoA and is present in more than half of CoA patients.S4.2.6-15 S4.2.6-21 Intracranial aneu- rysms may occur. Ascending aortic aneurysms are often found in those with BAV, and aneurysms are seen at the site of coarctation repair in the descending thoracic aorta or arch. Dissection can occur, presumably more likely in the setting of poorly controlled hypertension. Even with excellent repair, hypertension remains common and pre- disposes to later myocardial infarction, stroke, and HF. 