Case of Refractory Hypertension Controlled After Aortic and Mitral Valve Replacement and Coronary Artery Bypass Grafting.

Overview

This is a case of a patient with refractory hypertension, uncontrolled BP on six antihypertensive medications with mitral regurgitation, aortic insufficiency and coronary artery disease. The patient underwent mitral valve and aortic valve replacement and CABG. After surgery, the patient required no BP medications initially and more recently has required only two antihypertensive medications for good BP control. Mechanisms like alteration in medication adherence, weight reduction, change in kidney function, prolonged effects of cardiac anesthesia, and CABG, which are known to decrease BP after surgery were excluded. Most probably, the underlying mechanism likely contributing to the BP reduction was the reversal of the cardiac hyperdynamic state with reduction in SV after aortic and mitral valve replacement without change in HR, resulting in a favorable reduction in cardiac output and the consequential reduction in BP.