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High Blood Pressure

HTN med selection (from older retired FNP)

06/29/2009

Question:

I am 62 years old and a retired RN/FNP...I have taken Losartan 50 mg qd X 10 yrs..No SE...about a year ago I developed BPH and added Doxazosin..works well with still no SE...however, in the last 6 months, my puse has averaged about 100 (previously 70-80)..I`m wondering about changing from Losartan to something like Atenolol or Metoprolol...I`m 62 years old, retired after being an RN/FNP for 33 years, and cannot get health insurance due to pre-existing conditions (isn`t that a bummer!)...I would appreciate any suggestions...(oh, yes---I had a full PE with labs 6 months ago and everything was normal and WNL)...thanks

Answer:

If your resting heart rate is 100, you should indeed change your medications and try to lower the pulse to a rate closer to 60.
Neither losartan nor doxazosin have a significant effect on heart rate.

In you case, replacing losartan with metoprolol is a good option.  Atenolol is no longer considered appropriate for the treatment of hypertension.  If available, long-acting metoprolol (once a day dosing) would be a good choice.  It is available as a generic.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati