Why take a beta blocker if BP is already controlled?

Question

Hello doctor,

My father is 66 years old and has had hypertension for the past 25 years. He is currently on Olmesartan medoxomil and Amlodipine for hypertension and has been diagnosed with hypothyroidism for the past six years, for which he takes Thyroxine 50 mcg. He was recently diagnosed with atrial fibrillation, which is currently under control. He is now taking Acenocoumarol 3 mg, and his blood pressure is 120/80 mmHg. He is also using the homeopathic medications for heart support. He recently checked his INR, which came back at 1.51, and he has seen a doctor regarding this.

He has just started taking Acenocoumarol 3 mg. The doctor also recommended that he take Metoprolol succinate, but he did not start it because he could not easily find it in medical shops. My query is: since his blood pressure is controlled at 120/80 mmHg and he is not experiencing any palpitations, why should we start Metoprolol succinate (a beta blocker), as this may lower his blood pressure further? Why should a patient take more medications?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

Firstly, his INR (international normalized ratio) is not within the target range; it should be between 2 and 3. Therefore, his Acenocoumarol dose should be increased to 3 mg and 4 mg on alternate days (3 mg on one day and 4 mg on the next) and his INR should be checked after one week. The INR should be monitored monthly. Alternatively, if there are no financial issues, he can take Dabigatran, which is a blood thinner that does not require INR monitoring.

Next, regarding Metoprolol succinate, the reason for its prescription is to help control the heart rate, which may be on the higher side. This medication is also prescribed for preventive purposes, as his heart rate can intermittently rise to very high levels. Beta-blockers will help prevent this. Currently, he is not on any rate control medication. If his heart rate increases, his blood pressure may fall, leading to symptoms such as shortness of breath and chest pain. If his blood pressure falls significantly, the dose of Olmesartan can be decreased. If his blood pressure consistently stays below 110 mmHg, he should only take Olmesartan instead of Olmesartan and Amlodipine.

I hope this helps. Please feel free to reach out if you have any questions.

Answer 2

Hello,

Welcome back to icliniq.com.

Yes, a beta blocker is the first choice for patients with atrial fibrillation. Adjust the Olmesartan dosage if necessary. Atenolol is an older medication and is not frequently used nowadays; however, there is no significant difference between the two, so he can take it. Just start with 25 mg instead of 50 mg.

Best of luck!