The metoprol was added 2 years ago due to autonomic dysfunction which caused me to faint. It has helped a lot. I still have presyncope but so far have been advoiding full syncope.
Since adding it my bp has not been labile but heartrate slow. The heartrate doesn't really bother me. Does make it harder to walk at a faster speed it seems but I can't stand for long anyway or bp drops causing the fainting. To exercise I use a recumbant bike and do fine. I rarely get heartrate over 70 though exercising.
As for adjusting my meds I leave that up to my drs. My bp is still adjusting since going back on my regular med doses and is a little labile yet.
What baffles me is why after such a small adjustment my bp went so crazy. At 8:30 p.m. it was 108/67 and by 4 a.m. it was 190/106. Just makes no sense to me.
You take metoprolol, diltiazem, enalapril and telmisartan. The first two agents address primarily heart rate (HR) but are not great blood pressure (BP) drugs. Speaking of HR, what is the reason that you see an electrophysiologist? Atrial fibrillation? and are you feeling poorly when your heart rate is 40s?
I would say that if your HR needed to be a little faster than 40s, then adjust metoprolol or diltiazem as your had done, but then increase the enalapril and/or telmisartan to treat the blood pressure. IF labile blood pressure is an issue, I would take enalapril twice a day (even though commonly it is a once a day med, some people metabolize it faster). Also, adding another long-acting BP medication such as amlodipine might be helpful if HR is ideal but BP still too high. Lastly, have your doctors tried long-acting metoprolol and/or diltiazem for more stable HR/BP effect?