Can a patient with a blood pressure (BP) of 108/72 receive their home dose of 50 mg metoprolol (beta blocker)?

Administering Metoprolol with BP 108/72

Yes, the patient can safely receive their home dose of 50 mg metoprolol with a blood pressure of 108/72, as this BP is not low enough to contraindicate beta-blocker administration. 1, 2

Assessment of Blood Pressure Parameters

When evaluating whether to administer a beta-blocker like metoprolol, the key considerations are:

• Current blood pressure (108/72 mmHg)
• Presence of contraindications
• Patient's baseline medication regimen

A blood pressure of 108/72 mmHg is:

• Above the hypotension threshold of 90 mmHg systolic that would contraindicate beta-blocker administration 1
• Within a safe range for continuing home beta-blocker therapy 3

Guidelines for Beta-Blocker Administration

According to the 2013 ACCF/AHA guidelines, beta-blockers should be avoided when any of the following are present 1:

• Signs of heart failure
• Evidence of a low output state
• Increased risk for cardiogenic shock
• Systolic BP <90 mmHg
• PR interval >0.24 seconds
• Second or third-degree heart block
• Active asthma or reactive airways disease

The patient's blood pressure of 108/72 mmHg does not meet any of these contraindications.

Metoprolol Dosing Considerations

For patients on chronic metoprolol therapy:

• Maintenance doses of metoprolol are typically 50-100 mg twice daily 2
• The patient's home dose of 50 mg is within the standard therapeutic range
• Abrupt discontinuation of beta-blockers should be avoided as it can lead to rebound hypertension or exacerbation of underlying cardiovascular conditions 3

Special Situations

If the patient were to develop any of these conditions, dose adjustment might be necessary:

• Symptomatic bradycardia (heart rate <50 bpm)
• Worsening hypotension (systolic BP <90 mmHg)
• Development of heart failure symptoms

Clinical Decision Algorithm

1. Check current vital signs:

   • BP ≥90/60 mmHg? → Continue home dose
   • Heart rate ≥50 bpm? → Continue home dose
   • Signs of heart failure or shock? → Hold dose and reassess

2. In this case:

   • BP is 108/72 mmHg (>90 mmHg systolic) → Safe to administer
   • No mention of bradycardia or heart failure → Safe to administer

3. Administer the home dose of 50 mg metoprolol as scheduled

Monitoring After Administration

After administering the metoprolol:

• Monitor blood pressure and heart rate within 1-2 hours
• Assess for symptoms of dizziness, lightheadedness, or fatigue
• If systolic BP drops below 90 mmHg or concerning symptoms develop, consider holding subsequent doses and consulting with the prescribing physician

In conclusion, with a blood pressure of 108/72 mmHg, the patient's home dose of 50 mg metoprolol can be safely administered as this blood pressure is not in the hypotensive range that would contraindicate beta-blocker therapy.