Confusion over BP

[jmno]

I have a BAV and dilated aorta (4.4). My BP used to be around 100-110/60-70. It's now anything from 95-140/85-95. Should I be worried? I have moved locations a few times over the last few years and have received conflicting opinions from different cardiologists. I have now moved to Spain and am unsure about the kind of health care I will get (although I have had to get private cover and am not insured for previously diagnosed conditions) and communication is difficult as I don't speak the language well although I am learning. I'm 48 and my weight is well controlled, I'm reasonably fit but get breathless but depending on which consultant/GP I speak to this is either nothing to worry about or down to my hypothyroidism condition. Thanks so much for any advice you can offer.

[Cliff_G]

Hi jmno,

I don't know about any connection with hypothyroidism, though I wonder if you are on thyroxine?

As someone who has learned a lot about the aorta in recent years due to my own problems, I think your wondering about your BP is a correct consideration.

BP: the recommendation for BP control with a dilated aorta is no more than 120/80 resting average (and some say a max heart rate of 60). The standard 140/90 does not apply with a dilated aorta. BP will go up and down with activity, exercise, etc, and that's normal, and will vary to some degree even at rest. If your variation is happening while at rest, it might be best to get a 24 hour BP monitor, which is acknowledged best practice for monitoring BP, at night as well. This will give you and your doctors a proper indication, also to know whether your BP comparatively rises or falls at night helps.

If your BP is too often above 120, I think your doctors should be considering either beta blockers or ARBs, both of which not only help BP but also are thought* to have a protective effect on the aorta (*definitely in Marfan, probably with no Marfan-like condition). ARBs are not debilitating, beta blockers can be.

A small (2%) number of people with BAV will go on to have further problems with their aorta, and the fact that yours is 4.4 indicates you might be moving towards that proportion. The BAV causes blood to leave the valve as a jet and depending on which leaflets are fused, this jet can hit the wall of the aorta and slowly damage it. At 4.4 cm you should be having at least annual echo scans to measure diameter, as well as checking valve function, and as echo is not as accurate as other methods, you should also have at least one CT scan to cross-check against the echo.

I'm not sure of all the exact criteria which would result in having a new valve implanted, but basically any real loss of function such as being very short of breath, aortic murmur. Having a new valve would also protect your aorta better than not changing it, but it might not be the end of the story.

Many cardiologists will be up to speed on issues of aortic disease, more than just the valve, and I would urge you to check that whoever you see is one of those. An aortic specialist would be even better.

HTH

[jmno in reply to Cliff_G]

Thank you so much for that response Cliff_G, it's the most comprehensive detail I've ever had and I now understand it more.

I am on thyroxine for my thyroid but nothing at present for BP. I am having annual echos to monitor and up to my last one in October 2020 all was considered 'fine'. At the same time I had a 24hr BP monitor which was also 'fine'. So just told to come back in a year but since then have made the move to Spain and keeping a check on my own BP at the mo.

Often when we don't understand these things it's difficult to even know what questions to ask! I will try to find an aortic specialist and go from there forearmed with the info you have very kindly given. Thanks again and I wish you well on your own heart health journey.

JN

[Alisbabas]

Hi,

Interesting as I posted a few months ago about low blood and I too have a bicuspid valve and autoimmune underative thyroid. Doing lots of research it can cause low blood pressure.

I too get breathless. I know people with thyroid get what's called air hunger.

Take care

Ali