Metoprolol Administration in Hypertension and Bradycardia

Patient Assessment and Treatment

• The American College of Cardiology recommends assessing current heart rate and blood pressure, as a heart rate of 54 bpm indicates existing bradycardia and a BP of 184/79 indicates systolic hypertension requiring treatment 1, 2
• Avoid metoprolol in patients with existing bradycardia as it will likely worsen bradycardia, and consider alternative antihypertensive agents such as ACE inhibitors or ARBs, dihydropyridine calcium channel blockers, or diuretics 1, 2, 3, 5
• The American College of Cardiology suggests that metoprolol is contraindicated in patients with AV block greater than first degree or SA node dysfunction, cardiogenic shock, and decompensated heart failure 2, 3, 4
• If beta-blocker therapy is required, monitor heart rate and rhythm closely, start with the lowest possible dose, and consider cardiology consultation for possible pacemaker if bradycardia persists 2, 4