Background: Hypertension is common with potentially severe complications of end-organ damage if not recognized, characterized, and managed early. Defining the cause of hypertension, primary versus secondary, is critical to preventing complications and is much needed to manage its treatment course accurately. Some secondary causes of hypertension can be reversible if recognized early.

Case Presentation: A 72 y.o male with a history of hypertension and hyperlipidemia presents to the ED with progressive chest pain and left arm weakness with asymmetric upper extremities. A detailed clinical vascular examination and a systematic diagnostic approach are carried out to reveal severe left subclavian artery stenosis. The interventional radiology team performed an endovascular correction of the stenosis with improvement in the patient’s symptoms and hypertension.

Conclusions: In this case, a correctable cause of secondary hypertension in the elderly is depicted; it can be overlooked and treated as essential hypertension if not clinically astute.

Keywords: Hypertension; Essential hypertension; Secondary hypertension; Subclavian stenosis