Brief Answer:
Yes , Continue Etizola Beta as already advised..but Met XL dose to titrate

Detailed Answer:
Hi XXXXX, Welcome to HCM.

Well at your age group(i.e. 31yrs) and Sex Male, it's really unlikely to have Hypertension and Coronary Artery disease, so feel relaxed in that perspective.

Now Panic attack and Anxiety can off course be there. That's a different entity.

To overcome that , at first you need to sit down and think what are factors that is causing this. You have already mentioned one here(driving bike) , try to figure out what else is there and let me know.

Blood pressure reading is variable entity, so if you're anxious/ under stress full situation most likely it'll show what we call as False positive reading. So to eliminate that , it's always advisable to take blood pressure in a relaxed state , preferably by a medical professional and always take 3 readings and take the mean. Also try to take Blood pressure at sitting posture.

Now as your Doctor has rightly prescribed the ETIZOLA BETA 0.25 mg , it's better to continue it long term (2 months as you've already mentioned). It'll help you relax and calm down and for the time being you need to observe yourself how you stay after this as if needed , dosage can be further modified or a second drug can be introduced.

Now Driving, not only bike but any vehicles at this point is strictly prohibited. Please keep this in mind.

Also try to refrain yourself from smoking/alcohol as they tend to worsen the scenario.

Try to narrow down the things you like to do eg. reading, painting, listening music , watching movies and try to involve in them as they will not only keep your mind away but also in long term help to reduce the medications greatly.

As for your query , ETIZOLA Beta 0.25mg is safe to take at night . As for MetXL 50mg which you're taking in the morning , is needed to be titrated after this has been started. Also normal ECG is another good sign , which as I've already mentioned is most likely in your case and going in favour of reduction of Metoprolol in due course.

So my advice would be to maintain a Pulse & BP charting from morning to afternoon and then evening to night 2 hrs intervals (say from 7am - 9am till 5pm then again from 7pm to 11pm after about 3-5 days of starting of Etizola and see how it goes. Accordingly , we can take a call on the further dosage of MetXL and everything else.

As of now, stop worrying too much , just start the medications and move on.

Relax, everything's going to be just fine.

Take care.

Let me know how you stay further, feel free to discuss at any point of time.

Regards

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Brief Answer:
Withdrawal is a process.. don't focus on data.. let medicine do it's part..

Detailed Answer:
Hello XXXX,
Welcome back to HCM,

Firstly let me tell you that you can't withdraw Etizola Beta immediately as it'll cause cold turkey. So gradual tapering is advised followed by cessation.

But keep in mind that 2 months is just a data which is highly variable in most of the cases, means it can 1.5 or 3 or even more as there is no fixed timeline to that. It's human body we're discussing, every body has it's own unique mechanism with or without medication, so we need to see how yours act in the long run.

Well I'm sorry that you're going through all these for such a long time period at such an early age. Now I'd like to ask- are you under the treatment of the same doctor for past 6 yrs and is he a GP or a Cardiologist (I'll explain the justification of this question once I'll get the answer from your side) ?

You've rightly picked it up that any point of stress can cause the falsely elevated reading of BP but, if we exclude that parameter also , still there's some part of Hypertension component is definitely there otherwise some symptoms would've definitely shown in this 2.5 yrs while you're on Metoprolol .

You seemed to be on a series of cardio selective beta-blockers for these past few years , now it's time go for some other tests like a 2D-Echocardiography as it'll give right impression of cardiac morphology which can narrow down the most probable diagnosis in this case.

As for the last query, blood pressure ,if persistently high , definitely need anti-hypertensives and if taken under strict medical supervision , is definitely safe. Time duration is not a problem in this case.

Like I told you, it's time go beyond ECG as it can't give us every data.

Feel free to discuss further.

Take care

Regards

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Brief Answer:
You're always welcome to have my suggestions..

Detailed Answer:
Hello XXXX,
Welcome back,

Well even though your Doctor seems pretty experienced and the right one for this kind of problems , still there's no harm in opting for a Second opinion (a DM Cardiologist only) in this regards. I believe you must have already told him all this stress factors since you're in his follow-up for so long .

Now you can start using Etizola Beta as I've already mentioned along with those BP/Pulse charting and let him show the difference , which I believe will definitely trigger him to titrate the dose of Metoprolol further.

The point is , even if you seek for a review/2nd opinion, it'd be best to review after at least 3-5 days so that the medicines start taking their full effects.

So just do that , and in the meanwhile just start the new medication(at bedtime) along with the old one(in the morning) and see how it goes. I hope after this Met XL dosage will be reduced further and if everything goes well , it may even be stopped . But in either case a 2D-Echocardiography is a must to check out the Cardiac morphology and the coronaries to some extent.

My best regards. You're always welcome to have my suggestions in future.

Take Care

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