Content Sources:
1. Zehua Liu, Application and research progress of metoprolol in cardiovascular diseases." Chinese Journal of New Drugs 23.4 (2014): 424-428.
2. Wang Xiaoming, . "Current status of β receptor blockers in the treatment of hypertension—a case study of metoprolol." Journal of Clinical Rational Use of Drugs 7.28 (2014): 5-6.
3. Zhou Jianping, . "Analysis of the use of methorolol in cardiovascular disease and its effect on cardiac function." Chinese Journal of Modern Medicine 25.8 (2015): 112-114.
High blood pressure is a common health disease that affects a large number of people. According to data from the National Cardiovascular Center, the prevalence of hypertension among residents aged 18 and above in mainland China has reached 27.5%, with a total of about 245 million people. The specific evaluation criteria for hypertension are the results of three blood pressure measurements on the same day without taking antihypertensive drugs, systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg.
Han Bin, a 27-year-old native of Jiangxi, works in an Internet company, and the hard work of the people around him quickly infected him, often staying up late and working overtime, doing any dirty work, and being rated as an excellent employee every year. In August 2017, Han Bin went downstairs to help his colleague get documents, and found that the elevator was broken and had to climb the stairs.
After returning to the office, Han Bin stood at the air outlet and blew for a long time before returning to his workstation. When I was working overtime at night, there was an inexplicable tingling pain in the chest area, which dissipated on its own after more than ten seconds. When I got up to go to the toilet, I couldn't stand still, and my whole body was extremely heavy.
When he got home, Han Bin still felt dizzy, and his steps were as heavy as lead. Lying on the sofa, he quickly fell asleep, and in the middle of the night, he found that he was hot, and after taking his temperature, he really had a fever. Within a few days of taking the medicine, the symptoms were almost gone.
The time soon came to September, and the unit organized a unified physical examination. The positive Han Bin arrived at the scene early, and when his blood pressure was measured, the value was 150/98mmHg, indicating grade 2 hypertension. He took the report to the doctor's office for consultation, and after taking other indicators, the doctor prescribed him amlodipine to help control his blood pressure and remind him to pay attention to adjusting his lifestyle habits.
Han Bin carefully checked the drug instructions, and the side effects column made him a little scared, but thinking of the doctor's words, Han Bin still took the medicine on time and in accordance with the amount. After taking it for less than a week, Han Bin noticed that his lower limbs were swollen in a circle, like a white radish, and a deep pit could be formed when pressed with his hand.
This frightened Han Bin, and he remembered that one of the side effects was edema. After finding a doctor to explain the situation, the other party explained that this is because amlodipine is a calcium ion antagonist, which may cause edema if taken for a long time. The doctor first asked him to reduce the dose of the medication, and after a week of observation, the symptoms did not improve. So he changed the medication, and Han Bin began to take metoprolol.
Metoprolol is a β-receptor blocker widely used in the treatment of hypertension, coronary artery disease, angina, arrhythmias, and after myocardial infarction. It reduces heart rate, myocardial contractility by blocking the heart's beta1-adrenal receptors, thereby reducing the heart's workload and oxygen consumption.
Metoprolol is available in soluble and insoluble forms, of which metoprolol proton compounds are more commonly used, with metoprolol succinate being suitable for conditions that require rapid onset of action, such as angina, and metoprolol succinate being more suitable for treating chronic conditions that require long-term medication, such as hypertension, due to their sustained-release properties.
Since changing the antihypertensive medication, Han Bin has not had edema again, although he was a little dizzy in the first two days, he quickly adapted to it, and he had good results when measuring his blood pressure every day. After taking it for a year, Han Bin went to a follow-up visit, and his blood pressure was measured at 145/95mmHg, and even the doctor couldn't help but praise him for his good performance.
In the second year, Han Bin still insisted on taking medicine as before. On the evening of June 21, when he came home from a business trip, when he was packing his luggage, he always felt that his chest was tight, and his heart beat much faster than usual. I measured my blood pressure as soon as I could, and found that it was much higher than usual, so I hurriedly went to take blood pressure medication. Stayed in place for an hour, and the symptoms were relieved.
Soon the time for a second review will come. Han Bin was walking on the way home as usual, when a severe headache made him almost fall to the ground, and then the tip of his right finger was numb, and he couldn't move his entire right limb, and soon, he lost consciousness.
On admission, Han Bin's blood pressure was measured at 170/105mmHg. Brain CT examination showed cerebral hemorrhage in the right basal ganglia extracapsule area, with a bleeding volume of about 30ml and rupture into the right lateral ventricle.
After consultation with the family, emergency craniotomy and decompression surgery were performed. A few hours later, Han Bin was transferred to the ICU for observation and was not transferred to a general ward until his condition stabilized. The mother saw that Han Bin was full of tubes, and she fainted directly, and now the mother and son were lying on the hospital bed.
Not long after, Han Bin woke up, and his mother hurriedly stepped forward when she heard the movement. His father told him everything that had happened, and it was then that he realized that he had a cerebral hemorrhage due to high blood pressure. However, in the face of this statement, Han Bin was emotional and said to his family: "You go and call a doctor for me, they must be mistaken!" ”
Coincidentally, the doctor came to check on him. "I came for a follow-up examination last year, and you all praised me for keeping my blood pressure stable, how long has it been, how can I suddenly have a cerebral hemorrhage?" Han Bin hit the nail on the head and pointed out the problem. The doctor had an impression of Han Bin, and learned that the blood pressure medication Han Bin was taking was metoprolol.
After the preliminary exchange, Han Bin actively exercised, rarely stayed up late, and his diet was mostly light, and he couldn't find clues from his daily habits. Suddenly, the doctor remembered something and asked a question about the drug. Han Bin was puzzled by the other party's approach, but still nodded.
Looking at Han Bin's answer, the doctor said regretfully: "The most taboo thing about taking metoprolol is this behavior, as long as you do it once, it will soon cause cerebral hemorrhage, and even acute cardiovascular and cerebrovascular accidents such as cerebral infarction and myocardial infarction, and the consequences are unimaginable!" ”
Metoprolol, as a widely used β blocker, is mainly used to treat heart diseases such as hypertension, angina, and arrhythmia. It works by blocking the action of adrenaline on the heart's β-receptors, thereby reducing heart rate, myocardial contractility, and blood pressure. Although metoprolol plays a positive role in regulating cardiovascular function, in some cases, if not used or managed appropriately, it can lead to some serious consequences, including the risk of intracerebral hemorrhage.
Intracerebral hemorrhage, also known as intracerebral hemorrhage, is when a blood vessel in the brain ruptures and blood leaks into the brain tissue. This condition can be caused by a variety of causes, including high blood pressure, head trauma, vascular abnormalities, etc. While taking metoprolol, patients may increase the risk of intracerebral hemorrhage if they do not manage their blood pressure properly, especially if their blood pressure is lowered too much or too quickly. This is because too low blood pressure can lead to a lack of blood supply to the brain, which can lead to the rupture of blood vessels, especially if the existing blood vessels are weak or have abnormal blood vessel morphology.
In addition, although the effect of metoprolol in slowing the heart rate is beneficial to the recovery of some heart diseases, if the patient has undiagnosed cardiac disease or other auxiliary diseases, such as cardiomyopathy, severe arteriosclerosis, etc., this effect of lowering heart rate and blood pressure may cause an additional burden on the cerebrovascular system, and then cause cerebrovascular accidents.
In addition, patients taking metoprolol need to be careful when experiencing strenuous or unusual physical activity. Because sudden physical activity can cause rapid fluctuations in blood pressure, especially in the context of metoprolol's effect on blood pressure, these fluctuations may exacerbate existing cerebrovascular lesions or cause new vascular damage, further increasing the risk of intracerebral hemorrhage.
In summary, although there is no single behavior that can directly lead to intracerebral hemorrhage in all patients taking metoprolol, inappropriate blood pressure management, the presence of underlying cardiac or vascular pathology, and inappropriate physical activity may all work together to increase the risk of intracerebral hemorrhage in patients taking metoprolol.
Therefore, for patients taking metoprolol, maintaining close communication with their medical provider, using the medication correctly, maintaining stable blood pressure levels, avoiding strenuous physical activity, having regular cardiac and cerebrovascular health check-ups, and immediately reporting any unusual physical symptoms are key to preventing intracerebral hemorrhage.
The implementation of this series of measures can not only maximize the positive effect of metoprolol in the treatment of cardiovascular diseases, but also significantly reduce the risk of intracerebral hemorrhage that may be caused by drug side effects.