High Blood Pressure 3 months after AVR

[Franklin]

Hello everyone, it's been a while since my last post, but I'm now 3 months post surgery and am doing well. Back at work and am going to the gym (lightly).

My past few checkups have been good, both my cardiologist and physician say that everything sounds good, although my first post surgery echo wont be for another couple weeks. The only thing that worries me is that my blood pressure is high - 140/90 - 150/100. My cardiologist started me on 50mg Losartan 2.5 weeks ago, and my BP doesn't seem to have dropped at all.

Immediately after and for several weeks after my surgery, my BP was 120/80 (before the surgery, BP was 160/60 and as my surgeon says he "gave me a bottom number").

Has anyone else experienced this?

My theory (which I've run by both doctors, but neither has confirmed that it's a viable theory - they just sort of nodded along), is that my enlarged left ventricle is still pumping nearly the same volume of blood as it was pre-surgery, and now that I have a functioning aortic valve, the larger-than-normal volume of blood is causing elevated blood pressure.

Is that a possible theory or is it just ridiculous? I guess one problem with it is that I'm just starting to see elevated BP and I didn't see it right after the surgery...

Anyway, I'm a big guy...I played lacrosse at UNC which I know is 7 years ago at this point - time flies - but I'm still 6'3" and 230lbs...I'm working on getting down to 200lbs (or below) because the doctors say that will help with the BP, but does anyone have any other suggestions?

I'm on:
Coumadin 7.5mg
Metoprolol 100mg
Aspirin 162mg
Losartan 50mg
Have a 31mm (huge, I know) St Jude valve as of Jan 6th

Thanks in advance,
Franklin

 

[Bill B]

Your theory is not ridiculous. If anything your heart is pumping more volume than before surgery because a major restiction to flow has been removed. My surgeon said I might need BP medication for a year after surgery while my heart remodels. But, the regulation of blood pressure is very complex involving a variety of hormones and other organ systems, and as much as it has been studied, it can be hard to predict what will happen and why. For most people with high BP, the underlying reason for it is unknown and the treatment is rather non-specific.

My blood pressure was like yours but responded remarkably well to exercise and weight loss. After a few weeks of cardiac rehab, I was in much better control. I highly recommend cardiac rehab if you haven't done it.

 

[Bryan B]

Franklin,

I have experienced the same thing. My BP at my surgeon's office at my 3 week checkup was something like 105/70. The last 2 weeks I have noticed I could hear (actually feel) my heart beating more...especially when I laid down (bedtime) or bent over. I took my BP and it is now 135/90. My only heat med (besides baby aspirin) is Metoprolol 50mg twice a day. I took it upon myself (which my doctors are used to lol) to raise it to 75mg twice a day and it has helped a bit (knocked each number down by 5). I have a cardiologist appointment on Tuesday so I will let them decide what to do at that point (I am guessing 100mg twice a day or reduce Metoprolol and add another BP med). I think there could be a number of reasons causing the BP to go up, especially as we become more active. I think I know why mine has gotten higher. Like an idiot I have started back using tobacco in the last few weeks which naturally is going to raise my BP. All of my good BP readings after surgery were taken while tobacco free. I guess they will have to take that into account until I decide to quit (and am successful lol).

 

[Franklin]

Thanks very much for the replies Bill and Bryan. I figured that the theory sort of made sense. It’s nice to know that there are others that have experienced HBP after the surgery – I’m going to check with my cardiologist about upping my metoprolol or maybe my losartan because I’m looking forward to (hopefully – knock on wood) having normal vitals at some point. They say that losartan can take some time to work though.

It’s interesting that you mention that you can feel your heart beating more strongly, Bryan. I can feel that too, but I’m not sure whether it’s the metal clicking in my new valve or whether my heart really is beating more strongly? I'm not familiar with the Bentall Procedure - I'm glad it was successful and I hope your recovery is going well.

Bill, thanks for that suggestion. I will definitely look into cardiac rehab – I think my insurance actually covers it, so that’s good.

Speaking of insurance…I saw a bill from my surgery yesterday that said that the operation and inpatient stay was $79,939. I was sort of surprised, because it seems low to me. That’s at New York Presbyterian, which would presumably be one of the more expensive hospitals given the location. The insurance company payment to the hospital is something like $50,500. NYP was “in network” thankfully so my co-insurance was much less. Anyway, just though that was kinda interesting.

 

[Bill B]

Yes, it's routine for rehab to be covered. Go for it.

Definitely check with your cardiologist - you need to get this under better control. I worked with mine and his staff - also the cardiac rehab people I went to would intervene directly with the dr and his staff as well. Everybody wanted better control. I'm still on a good amount of BP medication, but until I started rehab, it didn't work very well.

Adding up everything, including all the pre and post op testing and care, my insurance paid about $100K. After decades of never having a single medical claim besides routine physicals, I think I surpassed all those premiums in a single incident. I'm just the tip of the babyboomer healthcare cost iceberg.

 

[wvu mountaineer]

I had AVR surgery on 10/20/11 at Emory Mid Town. It was fairly complicated with a Onyx mechanical valve and repair of my Mitral and Tricuspid valves. I recovered very quickly and was walking a mile a day while in the hospital. I kept the walking regimen up for the last few months and have felt great. Recently, I have noticed that my blood pressure and pulse rates were elevated. BP of 160 over 105 and pulse of 100. Before this week, my blood pressure was in the 130 over 80 range and pulse of about 65. I take 37.5 mg of Metropol twice daily. I don't know what is happening, but it only started to occur about three month after surgery. I weigh about 200 pounds and I'm 6'3". Any thoughts about this condition.

 

[carolinemc]

I am sorry to hear about the bp problem. I did not catch if you are a smoker or not, smoking is a agitator to the body. I just wondered, I had quit the habit a few months prior, no bp problems. But that is not always the case. And if you are under stress, it can raise bp also. I have to remember to relax at the doctor's office, get too nervous before appt. Good luck in getting to the root of it and beat it down. You will get it figured out soon.

 

[joey66]

I know this is an older thread, but I am curious if anyone has any updates on this situation? I had AVR surgery in November 2012 and have had exactly same experience. Pressures after surgery 124/85 (diastolic was up slightly from pre-surgery and was sort of expected because of the repair) Then a couple weeks ago it shot up to 160/100. Never before in my life has it been that high. My cardiologist says they have no explanation and that sometimes this happens. He gave me amlodopine 10 mg and that seems to have brought it back down. I am wondering if this is a "new normal" or if it gets better over time.

 

[marc_kowal]

My BP was always good before surgery and even immediately after surgery, but then about 2 /12 - 3 months after surgery it went up. My cardiologist put me on 10 mg of Lisinopril and that helped, but I eventually got sick and tired of the "Lisinopril cough" after about 6 mionths and he took me off of it. My BP eventually went back to it's old numbers and hasn't been an issue since.