Dear doctor, I am on longtime BP medicines, Metoprolol 50 mg and Losartan 80 mg once a day for two years. My BP went up to 145/100 often in the last month. I got a new medication from my doctor, Irbesartan 150 mg and Metoprolol 50 mg once a day. Now the BP is excellent, over the day 125/85. Pulse around 75. Now, my question is I tried to use Propranolol instead of Metoprolol in the same dosage as it helps my anxiety. But I got a general feeling of sick and dizziness. Propranolol instead of Metoprolol resulted in the same BP and pulse. Is there another beta-blocker such as Atenolol which could help my anxiety and not giving me the side effects as Propranolol?Age 41 years, male, height 175 cm and weight 72 kg.
Hi. Let me tell you very clearly that, Metoprolol is the drug of choice, not just for hypertension but it has shown to have mortality benefits to cardiac patients. It helps for that purpose by : So, I would suggest you carry on with Metoprolol. Now about Propranolol: It is also a Beta Blocker, but it is not "CARDIO SELECTIVE" but "NON SELECTIVE". I will explain how it is essential. There are mainly two receptors of Beta Blockers - Beta 1 and Beta 2. Beta 1 is for cardiac reception. So, Metoprolol acts on it and has advantages over non-selective. I suggest you take Metoprolol Succinate extended or controlled release since you are taking it once a day. In case if you are not taking, kindly ask your doctor to prescribe you extended release. I prefer to give Metoprolol extended release in twice daily dosing to have good control for 24 hours. You may continue with Irbesartan or Telmisartan. Another concern is that I would like to know if you have any of the following: 1. Diabetes. 2. Any skin disease. 3. Difficulty/diminution of vision. 4. Any tingling or numbness. Get your Serum Creatinine, Urine for albumin, fundus examination, baseline ECG. Now coming to your anxiety problem. We have to deal with it separately. I do not want you to stop Metoprolol, just for anxiety problem. Tell me exactly what feeling you have? Tell me in case you have any palpitations, and sweating, restlessness, breathing problem. Do tell me if you snore a lot in the night, Also how is your sleep.? For your main query, I will say in one line "You should continue with Metoprolol since you are tolerating it well". I hope I am able to answer your query, you may ask me if you have any further questions.