Hello doctor, I am 44 years old and diagnosed with preliminary hypertension. All my tests including ECG, TMT, 2D echo, brain CT scan, pulmonary embolism (to rule out the cause for sinus tachycardia), 48 hours Holter monitor, chest X-ray, lipid profile, and kidney and liver function tests. TMT, 2D echo, CBP, and vitamins are normal. I was prescribed Metoprolol tartrate 50 mg twice a day, Hydralazine hydrochloride 25 mg twice a day and Amlodipine 5 mg twice a day. As I had slightly high total cholesterol I was also prescribed Atorvastatin 10 mg. Doctors suggested two changes to the above medicine regime as follows:  Stop Hydralazine hydrochloride. Take Metoprolol succinate (extended release) instead of Metoprolol tartrate (immediate release).  So, currently I am on Metoprolol succinate XL 50 twice a day, Amlodipine 5 mg twice a day and Atorvastatin 10 mg once a day. My BP is very much controlled (110/80 mmHg), and heart rate average is 70 to 80 beats per minute. At night time it drops to 60 to 70 range. My cholesterol is very much under control, the total is 140, LDL is 73, HDL is 43. My specific questions are as follows:  Since I changed to Metoprolol succinate, I have identified that my hair is thinning. Does beta blockers cause hair thinning? Can I switch back to Metoprolol tartrate (immediate release) or is there any other beta blocker which is as effective and safe as Metoprolol and does not cause hair thinning? Metoprolol is also causing my HbA1c to go higher. It is now 5.4. Within one month of taking Atorvastatin, my cholesterol level has come down. I have been taking Atorvastatin for last one year. Can I stop it now? I do regular exercise. I walk 20 to 30 minutes on all days.
Hello. From the description it appears, you just have hypertension and no other problems. Firstly, just for hypertension, now beta blockers are not given as a first line medicine. It is given after calcium channel blockers (Amlodipine), ACE (angiotensin-converting enzyme) inhibitors (Telmisartan) and Hydrochlorothiazide fails. However, there is no harm in having it as a first line agent. Sometimes in less than one percent patients, Metoprolol can cause hair loss and also it does raise the HbA1c which does not require any treatment and it is acceptable. So considering these things, it is better to switch on other medicine like Telmisartan (Telma CTD 40/12.5 mg once a day). Also, if you want you may switch to Tartarate as well, but since its an immediate release formulation, blood pressure control may be inadequate at a later time period after medicine consumption. Also, the HbA1c issue will be there with all beta blockers. Another alternative beta blockers you may have Nebicard (Nebivolol) 5 mg once a day which we will increase gradually. So it is more like your personal preferences. But, seeing all these things, it is better to switch on to Telmisartan. If you are fine with hair loss thing then may be continued on Metoprolol. Succinate and Tartarate both can cause hair loss. You may stop Atorvastatin, continue to have healthy lifestyle including diet, regular exercises. Get lipid profile repeated after six to eight weeks to see for sustained control. For more information consult a cardiologist online -->