How to control high BP after an aortic valve replacement?

Question

Hello doctor,

My blood pressure is very high at 200/75 mmHg. I underwent aortic valve replacement surgery with a mechanical valve nine years ago. My blood pressure has been elevated for the past four days, and nothing has brought it down. In an emergency clinic, I was given a Nitroglycerin patch, which reduced my blood pressure to 170/75 mmHg, but it did not lower it further. My physician prescribed Perindopril and Bisoprolol. I am a chronic Warfarin user.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

There are multiple options available for you. Firstly, it may be better to switch to other medications such as Telmisartan 80 mg or Losartan 100 mg instead of Perindopril erbumine along with Indapamide, as combination drugs can make dose titration more challenging. If you prefer to continue with Perindopril erbumine with Indapamide, additional medications like Amlodipine 5 mg (and if needed, 10 mg) can be added along with Bisoprolol to help control your blood pressure.

If your blood pressure remains elevated, tablet Prazosin 2.5 mg can be introduced, with the dose increased up to 10 mg if necessary. Overall, your treatment could consist of Perindopril erbumine with Indapamide, Bisoprolol, and a third drug, such as Amlodipine or a similar medication like Cilnidipine. If further control is needed, Prazosin may be the next option.

Additionally, the dose of Perindopril erbumine with Indapamide could be increased later if required. In an emergency, you should discuss with your doctor the possibility of using intravenous Labetalol or an intravenous Nitroglycerin drip for immediate blood pressure control. Consult your specialist doctor, discuss with him or her, and take the medicines with take the medicines with their consent.

Thank you.