Coarctation of the aorta is an important differential diagnosis in adults with hypertension. Unfortunately, simply removing the obstruction does not restore cardiovascular normality. Patients may continue to be hypertensive, demonstrate abnormalities of endothelial function and remain at risk of premature coronary artery disease and other vascular disease. Therapy therefore requires both relief of the mechanical obstruction and long-term follow-up to deliver optimal antihypertensive therapy, vascular risk factor modification and detection and management of complications (such as bicuspid aortic valve and cerebral aneurysms). This paper discusses the management of three cases of this condition.