Metoprolol — Increase to Treat Increased Diastolic BP?

I'm far from a trained medical expert, and in fact have no medical training whatsoever. I am an AF patient who has had AF paroxysmally for eight years, and had two ablations. My understanding of metoprolol is that it is both a rate control medication and a force control medication. It reduces fibrillating rates (won't do much for flutter) and it also makes the myocytes less efficient by blocking their ability to contract forcefully. So, less pressure, and a longer refractory period where the vessels open up and relax longer. However, and this is where I find myself puzzled, I always thought that metoprolol acted in the systolic mode, not in the diastolic mode. Does metoprolol improve diastolic release? It turns out that it does:
https://biologyinsights.com/do-beta-blockers-lower-diastolic-pressure/
So, on the face of it, it would seem your physician friend knows what she is doing. Further, it is common to have rises in a prescription dose for metoprolol, just as it is for a statin. As our bodies age, as our disorders progress (AF is a progressive disorder), we need more help. Without an ablation or a pacemaker, it must fall to drugs. If it helps, by the time I was granted my first ablation I was up to 75 mg of metoprolol BID. That's a total of 150 mg. The max dose for metoprolol for 'non-heart failure' patients is 200 mg, so I was starting to get up into proverbial nose-bleed territory...dizzying heights. BTW, it's one of the cautions about using too much metoprolol. Some people with otherwise fit hearts may find that a newly increased dose puts them at a resting heart rate below 40 BPM, which is generally not good. It can lead to shortness of breath, swollen ankles, dizziness, ringing in ears, fainting...................falls........so do let your cardiologist know immediately if you find your balance wonky, if you stumble lots, fall, faint. There's a really good chance it's the metoprolol.

SECOND OPINION??? --ABSOLUTELY THAT AMOUNT OF MEDICATION ON ONE READING. YIKES. I KEPT MY BLOOD PRESSURE READINGS FOR MORE THAN 2 WEEKS AT HOME WITH MY OWN BLOOD PRESSURE MACHINE. RUNS 114/68 TO 98/57 NO MEDS PERSCRIBED. JUST MY OPINION. DO WHAT YOU ARE CONFORTABLE WITH.

@mzpat How do you feel when your Diastolic Blood Pressure is in the 50’s? Thanks for you help!

@gloaming Thanks for your help! Sorry to hear you have AF and you are maxing out on Metoprolol. Coincidentally or not, I have been seeing notices on my home Blood Pressure machine that I have “irregular heartbeats”. Yes, I can relate to you having to wait until things get bad before you can get any surgery or intervention procedure. Did the ablations help you? So, if AF is progressive (sorry to hear that!), will it inevitably lead to some kind of surgery? Thank you for reminding me that my current 25 mg. metoprolol dose a day is really not that much!

@mikeydc2008 I had two catheter ablations to control the AF, which has been in 'remission' for just over three years now. I haven't had to take metoprolol since partway through the three month 'blanking period' that follows an ablation. Basically, the blanking period is accepted as about three months of waiting for the heart to calm, for the lesions created during the ablation procedure to scar over and to form a tight seal of scar tissued surrounding the focus of the rogues signals that cause AF in those who have that arrhythmia, and then a Holter Monitor or a loop recorder is used for about a day to confirm that there is still/is no longer any evidence of AF happening. So, I haven't had to take anything except a direct-acting oral anti-coagulant and a statin ever since. I'm good! 😀

@mikeydc2008
ON THE DAYS THAT MY BLOOD PRESSURE IS LOW I DO VERY LITTLE. I EXPERIENCE LACK OF STRENGTH, CONFUSION AND AN ATTITUDE OF "NO DOING ANYTHING TODAY".
IT DOESEN'T GO THAT LOW VERY OFTEN, BUT WHEN IT HAPPENS.. I TAKE GOOD CARE OF MYSELF. IT ONLY HAPPENS ABOUT ONCE EVERY 3 WEEKS AND ONLY LASTS FOR THAT ONE DAY. FOR THAT REASON I AM NOT THAT CONCERNED ABOUT IT. MAYBE I SHOULD MENTION THAT I AM 87 AND TAKE NO MEDICATIONS PERIOD.

Why do you think that happens (one day in three weeks your blood pressure goes low)? Has a doctor or a nurse ever explained it to you? I ask that because I am finding it very difficult to get any explanations from cardiologists. Thanks!

@mikeydc2008
NO REASONS GIVEN BY CURRENT CARDIO DOCTOR OR THE NURSE. THAT IS WHY I AM GETTING A SECOND OPINION FROM A CARDIOLOGIST THAT IS WITH A DIFFERENT MEDICAL GROUP . I SEE THE NEW MD ON THE 10TH. LOOKING FORWARD TO GETTING SOME ANSWERS. IF NOT, I WILL GET A 3RD.

@mzpat I hope you find some smart and caring doctors and nurses!

Overreaction on your Drs part based on what you stated. Any changes should be be based on a series of readings over time…imho.