From the Guidelines
Metoprolol 25 mg is not suitable for a patient with a blood pressure of 98/60 mmHg, as it may worsen hypotension and lead to serious complications. Beta blockers like metoprolol work by blocking certain receptors in the heart and blood vessels, which reduces heart rate and lowers blood pressure 1. In a patient who already has low blood pressure, metoprolol could exacerbate the hypotension, potentially leading to dizziness, fainting, inadequate organ perfusion, or other serious complications. According to the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, beta-receptor antagonists like metoprolol should be avoided in patients with signs of heart failure, low output state, increased risk of cardiogenic shock, prolonged first-degree or high-grade AV block, or reactive airways disease 1. Additionally, the 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction recommends that beta blockers be initiated orally, in the absence of contraindications, within the first 24 hours, and that greater caution is suggested in the early use of intravenous beta blockers, which should be targeted to specific indications and avoided with heart failure, hypotension, and hemodynamic instability 1. Some key points to consider when prescribing beta blockers like metoprolol include:
- Selectivity: Metoprolol is a beta-1 selective blocker
- Partial agonist activity: Metoprolol has no partial agonist activity
- Usual dose for angina: 50 to 200 mg twice daily
- Monitoring during intravenous beta-blocker therapy should include frequent checks of heart rate and blood pressure and continuous ECG monitoring, as well as auscultation for rales and bronchospasm 1. If a patient with hypotension is currently taking metoprolol, they should consult their healthcare provider about adjusting the dose or switching to a different medication. The provider might recommend temporarily reducing the dose, taking the medication at a different time of day, or discontinuing it altogether depending on the clinical situation. The underlying cause of the hypotension should also be investigated and addressed. For patients who need a beta blocker for conditions like heart failure or arrhythmias but also have hypotension, careful monitoring and dose adjustment under medical supervision is essential.
From the FDA Drug Label
CONTRAINDICATIONS ... systolic blood pressure < 100 mmHg; The FDA drug label does not answer the question directly regarding the specific dosage of 25 mg, but it does state that metoprolol is contraindicated in patients with a systolic blood pressure < 100 mmHg.
- The patient's blood pressure is 98/60 mmHg, which is less than 100 mmHg.
- Contraindication exists for patients with systolic blood pressure < 100 mmHg. Given this information, metoprolol 25 mg is not suitable for a patient with a blood pressure of 98/60 mmHg due to the risk of further lowering blood pressure 2.
From the Research
Metoprolol Administration in Hypotension
- Metoprolol is a beta-blocker commonly used to treat hypertension and angina pectoris 3.
- However, in cases of hypotension (low blood pressure), administering metoprolol may not be suitable, as it can further lower blood pressure.
- A study published in 2018 found that metoprolol was associated with systolic orthostatic hypotension compared to other medications 4.
Orthostatic Hypotension Considerations
- Orthostatic hypotension is a condition characterized by a drop in blood pressure upon standing, which can increase the risk of falls and cardiovascular disease 5.
- Medications, including beta-blockers like metoprolol, can contribute to orthostatic hypotension 5.
- In patients with hypotension, it is essential to carefully consider the potential risks and benefits of administering metoprolol, particularly if the patient is already experiencing symptoms of orthostatic hypotension.
Dizziness and Blood Pressure
- Dizziness is a common symptom that can be caused by blood pressure dysregulation, including orthostatic hypotension 6, 7.
- Evaluating and managing dizziness requires a thorough assessment of the patient's symptoms, medical history, and physical examination findings, including orthostatic blood pressure measurement 7.
Administration of Metoprolol 25 mg in Hypotension
- Given the potential risks of metoprolol in patients with hypotension, administering 25 mg of metoprolol to a patient with a blood pressure of 98/60 mmHg may not be suitable 3, 4.
- It is crucial to carefully evaluate the patient's individual needs and consider alternative treatment options to avoid exacerbating hypotension.