We report the case of a 26-year-old male patient diagnosed with Takayasu arteritis after 4 years of first manifestation. He developed sensorineural hearing loss in left ear, followed 2 years later by acute onset paraparesis and hypertension, and followed another 2 years later by short duration of upper backache, chest pain, palpitations, and breathlessness. On examination, he had hypertension without any significant blood pressure (BP) difference within arms with all peripheral pulses palpable. Diagnosis confirmed with computerized tomography aortography showing multifocal wall thickenings in entire aorta. In our case, the first presentation was otological followed 2 years later by hypertension. Our report points toward fact that hypertension, though the most common, may not be the first manifestation and characteristic examination finding of BP difference, and pulselessness may not be seen in all cases. High risk of suspicion and early use of specific investigation in cases of multisystem involvement in young hypertension are crucial for timely diagnosis.