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Q. How can high BP be controlled in a patient with aortic valve replacement?


Hello doctor,

My BP is very high 200/75. I have made aortic valve replacement surgery with metal valve nine years ago. The BP is high for the past four days and nothing gets it down. In an emergency clinic, they gave me a Nitroglycerin patch which made my BP reach 170/75, however, it did not get the BP more down. My physician prescribed me Coversyl 5/2.5 and Concor 5. I am a chronic Coumadin user.

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Dr. Sagar Ramesh Makode
Cardiology, General Medicine, Internal Medicine


Welcome to icliniq.com.

There are multiple options available for you. Firstly, it is better to shift to other drugs like Telmisartan 80 mg or Losartan 100 mg instead of Coversyl plus because combination makes it difficult to titrate. If you want to stick to the same then some other medicines like Amlodipine 5 mg and if not effective 10 mg in addition to Coversyl plus and Concor, will control your BP. Also, if BP remains elevated then tablet Prazosin XL 2.5 mg should be added which can be increased to 10 mg if necessary.

So, overall, you may have tablet Coversyl plus, Concor and the third drug should be added like Amlodipine 5/10 mg (or similar medicine Cilnidipine). Next in the line if necessary is Prazosin. Also, the dose of Coversyl could be increased later if necessary. In an emergency situation, you should discuss with your doctor regarding intravenous Labetalol or intravenous Nitroglycerin drip for immediate BP control.

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