Hi, Bystolic and Lotrel are both blood pressure medications known as beta-blockers and calcium channel blockers, respectively. Beta-blockers can cause a slow heart rate as a side effect, but this usually only occurs at high doses. Calcium channel blockers like amlodipine are less likely to cause a slow heart rate, although it is still possible. Niaspan is a form of niacin, a B vitamin that is sometimes used to lower cholesterol levels. Niacin can also cause a slow heart rate, but this is a rare side effect. Zocor is a statin medication used to lower cholesterol levels. Statins are not known to cause a slow heart rate. It is possible that the combination of these medications, particularly the beta-blocker Bystolic, could have contributed to your slow heart rate. However, it is also possible that there are other underlying factors contributing to your heart rate, such as a problem with the electrical system of the heart. If you have been advised to get a heart pacemaker, your healthcare provider has likely determined that this is the best course of action for you. A pacemaker can help regulate your heart rate and prevent dangerous symptoms or complications. It is important to continue taking your medications as prescribed and follow your healthcare provider s recommendations to manage your hypertension and high cholesterol levels. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Priyanka, General & Family Physician