Hello doctor, My father is 66 years old, has hypertension since past 25 years, is on Olmark A 40 and hypothyroidism since past six years and taking Thyronorm 50 mcg. Recently, diagnosed with atrial fibrillation with controlled rate. He is taking Acitrom 3 mg now, his blood pressure is 120/80 mm of Hg. He is on homeopathic mother tincture crataegus for the heart. Recently, he has checked his INR which came 1.51. He had shown to a doctor. He only started Acitrom 3 mg. He also said to take Met XL 25. But as he could not get it easily from medical shops, he did not start. My query is when his blood pressure is controlled to 120/80 mm of Hg and is not having palpitation, then why should we start Met XL 25 (beta blocker), as this may lower the blood pressure again? why should a patient take more medicines?
Hello. Firstly, his INR (international normalized ratio) is not in range. It should be between 2 to 3. So, his Acitrom (Acenocoumarol) dose should be increased to 3 and 4 mg on alternate days (3 mg on one and 4 mg on the next day) and get his INR checked after one week. INR should be checked monthly. Alternatively, if there are no financial issues, then he can have tablet Dabigatran, which is a blood thinner and does not require INR monitoring. Next, regarding Met XL (Metoprolol Succinate), the reason for the prescription is to control the heart. His heart rate may be on the higher side. So, he might have started. Also, this is for preventive purpose as well. His heart rate intermittently may rise to a very high level. So, beta blockers will prevent it. He is not on any rate control medicine at present. If heart rate increases, then his BP may fall, and he will have shortness of breath, chest pain, etc. If BP falls significantly, then the dose of Olmark (Olmesartan) can be decreased. If BP persistently stays below 110, then he should have just Olmark instead of Olmark A (Olmesartan and Amlodipine). Hope this helps you and get back if you have any doubts. For more information consult a cardiologist online -->