Managing Blood Pressure After Aortic Dissection: Medication Changes Explained

After changing the medication, the blood pressure is around 100?

Hello Doctor: I am currently 38 years old and experienced a type B aortic dissection four years ago, for which I had an aortic stent placed.
Since then, I have been on medication to control my blood pressure.
Until two months ago, I was taking medication four times a day, and my blood pressure was maintained at a systolic pressure of 110-120 and diastolic pressure of 70-80.
Due to circumstances, I was unable to return to my original hospital for a follow-up appointment, so I visited a regional teaching hospital (which is also where I had my surgery).
The doctor informed me that the medications I was previously taking were older formulations and that he was unable to prescribe medications based on the prescriptions from another hospital.
Therefore, he changed my regimen to two doses per day.
Over the past two months, I have closely monitored my blood pressure before meals, which has been approximately 98-105 systolic and 70-80 diastolic.
I would like to ask if this situation is favorable for someone who has undergone surgery.
Below are the previous and current medications:
Previous medications:
- Aspirin Protect 100mg (morning)
- Carvedilol HEXAL 25mg (morning and evening)
- Doxaben XL 4mg (before bed)
- Exforge (combination) 5/80mg (morning)
- Zanidip 10mg (noon)
Current medications:
- Biso 5mg (evening)
- Bokey EM 100mg (morning)
- Sevikar HCT 40/5/12.5mg (morning)
Thank you very much for your patience in reading and responding to my message.
Thank you.

Lü Pinxie, 30~39 year old female. Ask Date: 2022/12/16

Dr. Wu Xueming reply Cardiology

Blood pressure is slightly low; it is recommended to reduce Sevikar HCT to half a tablet.

Reply Date: 2022/12/16

More Info

Managing blood pressure after an aortic dissection, especially after the placement of a stent, is crucial for ensuring long-term health and preventing complications. Your case presents an interesting scenario where medication adjustments have led to a change in blood pressure readings, and it’s important to analyze the implications of these changes.

Firstly, it's commendable that you have been actively monitoring your blood pressure. The readings you provided, with systolic pressures ranging from 98 to 105 mmHg and diastolic pressures around 70 to 80 mmHg, indicate that your blood pressure is currently on the lower side of the normal range. This is a significant change from your previous regimen, where your blood pressure was maintained between 110-120 systolic and 70-80 diastolic.
The medications you were previously taking included a combination of antihypertensives and an antiplatelet agent (Aspirin). The switch to a new regimen, which includes Biso (Bisoprolol), Bokey EM, and Sevikar HCT, suggests a move towards a more modern approach to managing hypertension. Bisoprolol is a beta-blocker that can help reduce heart rate and lower blood pressure, while Sevikar HCT combines an angiotensin receptor blocker (ARB) with a diuretic, which can be effective in controlling blood pressure.
The reduction in the frequency of medication from four times a day to twice a day can be beneficial for adherence, as it simplifies your regimen. However, it is essential to ensure that this new regimen effectively manages your blood pressure without causing it to drop too low, especially considering your history of aortic dissection. Low blood pressure can lead to inadequate perfusion of vital organs, which is particularly concerning in patients with a history of vascular issues.

Your current blood pressure readings, while lower than before, are still within a safe range. However, it is crucial to maintain a balance. Blood pressure that is too low can lead to symptoms such as dizziness, fatigue, or fainting, which can be particularly dangerous for someone with your medical history. It is advisable to keep in close contact with your healthcare provider to monitor these changes and adjust medications as necessary.

In terms of whether this situation is good for someone who has undergone surgery for aortic dissection, the answer is nuanced. On one hand, well-controlled blood pressure is essential for preventing further complications, including the risk of another dissection. On the other hand, excessively low blood pressure can pose risks as well. Therefore, it is vital to find a target blood pressure that is effective for your health without being too low.

In conclusion, while the changes in your medication and the resulting blood pressure readings are promising, it is essential to continue monitoring your blood pressure closely and maintain regular follow-ups with your healthcare provider. They may consider adjusting your medication further if your blood pressure remains consistently low or if you experience any symptoms. Always communicate any concerns or symptoms you experience, as this will help your healthcare team make the best decisions for your ongoing care.

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