Blood pressure

[Paleowoman]

I'm writing this following another thread. My blood pressure has increased since I had aortic valve replacement two years ago. Prior to AVR my usual blood pressure was around 95/65 to 100/70. I was also asymptomatic - truly asymptomatic, not my imagination. I did not have any regurgitation, just severe/critical stenosis. Since AVR my blood pressure has been usually in the range 120/80 to 140/95. My cardiologist doesn't seem concerned because of the sometimes lower readings, but I don't think it's so good and am wondering what could be the cause.

What are other peoples' blood pressure pre and post surgery ?

 

[pellicle]

Hi

... My blood pressure has increased since I had aortic valve replacement two years ago. Prior to AVR my usual blood pressure was around 95/65 to 100/70..... Since AVR my blood pressure has been usually in the range 120/80 to 140/95. My cardiologist doesn't seem concerned because of the sometimes lower readings,

well my view is that your range is now "normal" to "slightly high" and mine has been in that range all my life. Down at the 95 area I'd be concerned that it was tending too close to low

I've had no change pre and post surgery/surgeries and most of the time sits within that (occasionally I'll see a 110. From http://www.bloodpressureuk.org/BloodPressureandyou/Thebasics/Bloodpressurechart

I know when I'm agitated or stress I can feel my heart beat stronger (since my mechanical valve) and have taken the time to make BP readings out of interest. Sure enough, its more like the 140 when I'm stressed.

Best Wishes

 

[MethodAir]

In the week before surgery...150 over around 65 (not resting)...high pulse pressure. The first time I had noticed something awry, my diastolic was in the 30s suddenly. People said they had never felt a stronger pulse.

Before I was running into issues, non resting 130 over 80.

In the month after surgery, 95 over 65 hr 80. Now walking around midday, 117 over 70 hr 62.

I now have a very loud systolic aortic outflow murmur (that wasn't there in the first few months post surgery), as cardiac output has increased.

 

[Paleowoman]

Thanks Method Air and Pellicle. I never test my BP when I am not rested, that is I sit and relax for at least five minutes before taking it as that's how one should take it - no food or drinks the previous hour, both feet on the gournd, no talking ! I wouldn't take it when I'm feeling stressed, consciously at any rate ! I have a very loud outflow murmur too, but that's normal.

I would think you might be practically dead with a dastolic pressure of only 30 Method !

 

[rakesh1167]

Paleogirl I remember a member posting here with his diastolic pressure of 0(it is not a typo) before his surgery!!!. 30 is not that unreal for leaking valves.

 

[Paleowoman]

Yes I know, if someone has a leaking valve then the distolic pressure goes really low and it's pretty dangerous. My valve never leaked, mine was stenotic.

 

[epstns]

Anne - Before surgery my BP was slightly elevated. Most days it hovered around 140/90 or so. I was treated with an ARB (Avalide) which dropped it and kept it under control. After valve surgery they changed my meds. I now take metoprolol (beta blocker) for rhythm management (along with my pacemaker), and a diuretic (HCTZ) to help keep BP under control. With these meds, my BP is back to around 140/95 in the AM, before I take my daily meds. My cardio checks it whenever I see him, always in the afternoon, and it is usually around 120-130/80-95. He is not concerned with the range or the variability. (I am under instructions to call him if my BP starts to trend out of range.) He also says that his opinion is that with a tissue valve, having BP on the higher end of the "normal" range is optimal, as it takes more pressure to completely open the valve's leaflets. I haven't tried to confirm his opinion, and as long as things remain stable, I'm going to leave it the way it is.

 

[Paleowoman]

He also says that his opinion is that with a tissue valve, having BP on the higher end of the "normal" range is optimal, as it takes more pressure to completely open the valve's leaflets. I haven't tried to confirm his opinion, and as long as things remain stable, I'm going to leave it the way it is.

Now that's really interesting Steve ! I shall ask my cardiologist when I see him at my next echo in February what he thinks is the reason, though he doesn't seem to be concerned about my BP, it's only me that wonders why it's up since AVR.

 

[pellicle]

Hi

..., though he doesn't seem to be concerned about my BP, it's only me that wonders why it's up since AVR.

probably your heart is remodelling after surgery. Before it had a pressure restrictor (the stenotic valve) which acted like a disc insert to restrict flow in hydraulic systems. Now that it can push harder and "get some benefit" it is.

conjecture on my part ... but serious conjecture all the same.

 

[Paleowoman]

Oh yes - I suppose when the valve is stenotic, although the heart muscle can 'push' the blood through the valve with whatever pressure it can muster depending on the strength of the muscle, the pressure on the other side of the valve will be less due to the "restricted flow", and this may mean the pressure in the rest of the vascular system will be much lower ? So now, post AVR, that the blood flows without so much restriction through the valve the blood pressure (on my arm) will be higher than before.

 

[epstns]

This could be the case - that the heart can now pump with more pressure than before since the restriction has been removed, but at least in my case, my heart did not remodel back to a lower pressure situation. Mine has remained higher than "normal" although that's become normal for me over the past 5 years.

I'm thinking that as long as my BP stays in the "pre-hypertension" range, it will be OK. If it starts to trend upward, my cardio and I have agreed that we will revisit medications to get it back where we want it.

Better living through chemistry, I guess. . .

 

[Paleowoman]

I shall keep an eye on things Steve ! I only check my BP in the month before I have my cardiology reviews - I don't want to get neurotic or obsessive about it

 

[Capizzi]

My pre-mitral repair BP was almost always 120/80. Post-surgical BP varies widely, sometime really low and other times dangerously high. I had headaches as I tried to increase exercise. My stress test was terminated because my BP was 200+/157 before I broke a sweat -- this was only while exercising vertically. I started taking Lisinopril in the morning before swimming practice. I try to swim slow (HR<130) and avoid flip-turns; lowering my head is still causing me to almost faint or be painful. The medication gave me a different kind of headache, but I think I'll need it for a while (concern for kidneys/stroke). Pellicle talked about remodeling, and I think I'm still in that phase. My last echo report noted that my heart has been getting smaller (!). Loss of blood pressure auto-regulation post-surgery is mentioned a lot in the literature. I think the longer you have lived/adapted to poor blood delivery, the longer the remodeling takes.

 

[bluefields409]

I am just past the 1.5 year point since AVR (bovine). Hypertension is my nemesis still and it is nothing even with meds to have BP ranging between 160/108 to 210/140. Required monthly trips to cardiologist and echo's bimonthly keeping an eye on things. Stroke risk undeniable and edema , left leg only, an annoyance. Regardless, working away and living life and about to embark on trip that had to be cancelled due to last surgery. Going to keep on going until told NOW time for Bentall procedure. Not sure if I have "remodelled" but I do fit in jeans that didn't before surgery. :Face-Smirk:

 

[Paleowoman]

This "remodeling" - I looked that up and it seems the heart "remodels" when it changes in response to problems, eg left ventricular hypertrophy is "remodelling", so "remodeling" is something "bad" (even though it sounds good): https://en.wikipedia.org/wiki/Ventricular_remodeling

My heart hadn't "remdoled" prior to surgery so there's no "unmodeling" for it to do post surgery

 

[neil]

as am on blood pressure tablets this makes interesting reading

 

[pellicle]

Hi

This "remodeling" - I looked that up and it seems the heart "remodels" when it changes in response to problems, eg left ventricular hypertrophy is "remodelling", so "remodeling" is something "bad" (even though it sounds good): https://en.wikipedia.org/wiki/Ventricular_remodeling

yeah, its a term to make less words out of "the changes that happen to muscles when they are put under stress" ... pretty much what happens to your other muscles when you start weight training or stop it.

My heart hadn't "remdoled" prior to surgery so there's no "unmodeling" for it to do post surgery

while it may have not been visible to the x-ray or MRI there must have been some stresses on your heart or quite frankly they would not have operated. So like some people who go to the gym and gain strength but no observable changes to their physique I reckon that the changes were there but not easily observable, and now that the stesses are off its changing back to reflect the new (post surgical) situation.

 

[Paleowoman]

That makes sense yes - they certainly thought it was time to operate so there must have been stresses on my heart.

 

[epstns]

Also note that all this "remodeling" is just like working on a house remodel -- it takes a lot more time than we thought it would.

As our hearts slowly changed to compensate for failing valves, they may also take years to reach their "final" state of remodeling after valve replacement. I think this is also why many of us do not feel "healed or normal" for a year or so after surgery.

 

[MethodAir]

Hi
yeah, its a term to make less words out of "the changes that happen to muscles when they are put under stress" ... pretty much what happens to your other muscles when you start weight training or stop it.

The context I've most often seen for heart remodellng are the changes in response to pathology (as opposed to healthy adaption to exercise). A regurgitating aortic valve that causes a blood volume overload that dilates the left ventricular. Or ventricular hypertrophy from a pressure overload from a stenotic valve. Or combination of the two. Then there's reverse remodeling when the condition is treated and the heart transitions back to a healthy state.