Q. Why should one take beta blocker when blood pressure is already controlled?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 28, 2018 and last reviewed on: Aug 20, 2020

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?



Welcome to

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 -->

Thank you doctor,

That means we should start beta blocker irrespective of taking Olmark A 40, and if BP goes down, then we have to make changes in Olmark rather than making any changes in beta blocker. Can he take Atenol 50 mg instead of taking Met XL 25 mg?



Welcome back to

Yes, beta blocker is the first choice in patients with atrial fibrillation.

Do changes in Olmark if needed.

Atenolol is an old medicine and is not frequently used nowadays. However, there is no significant difference between the two and he can have that. But, start with 25 mg, not with 50.

All the best.

For more information consult a cardiologist online -->

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