Have a patient with an elevated baseline HR that you are treating for hypertension? Are you considering putting them on a beta blocker? Then you should consider nebivolol (Bystolic) over the older beta blockers such as metoprolol, atenolol, or bisoprolol.
Nebivolol is 37-40x MORE cardioselective than the other older beta blockers. What does this mean? It means a decreased chance of causing side effects often seen with other beta blockers. This is ESPECIALLY important in your patients who are fatigue prone or for men who want to maintain erectile function.
Therefore, if you are considering putting a patient on a beta blocker, then consider nebivolol if you are concerned about beta blocker side effects!
Is there a taper when switching? I have a patient who has been in metoprolol XR 50mg for several years. Having increasing fatigue and some intermittent ED. I checked his testosterone and it is in 700’s.
I don’t think a taper is necessary.
Compensatory tachycardia – heart has difficulty pumping against increased arterial resistance so it’s normal for heart rate to increase in hypertension. Get a sleep study, especially with hypertension, tachycardia, and with the added factors of fatigue, ED.