DEAR DR. ROACH: My husband has been on metoprolol for about eight years. He was prescribed that medication right after he had a stent put in due to a clogged heart vessel. He is doing very well. His recent stress test was normal. The metoprolol took his heart rate down to a pulse of between 55 and 60 shortly after he started it. He is an active 79-year-old and in good shape. But he was told years ago when the metoprolol lowered his pulse that he may eventually need a pacemaker.
If the metoprolol is giving him a lower heart rate, causing a future need for a pacemaker, I would think the cardiologist would just give him a different blood pressure prescription that doesn't lower the heart rate. He does not want a pacemaker due to a medication side effect. Do you think a replacement for the metoprolol would keep his pulse in the normal range and dismiss the thought of a future pacemaker? — N.F.
ANSWER: Metoprolol — commonly used in patients with coronary artery blockages — is a beta blocker, and it works mainly by slowing the heart rate down and by decreasing how hard it contracts. Beta blockers reduce the risk of further heart attacks and death in people with coronary artery disease, and they should be given to most people with CAD unless there is a good reason not to. They also may act to reduce rhythm disturbances by counteracting adrenaline in the blood.
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A heart rate of 55-60 is not unusual in people taking metoprolol. However, if a person had a heart rate that slow without a beta blocker, a doctor would be concerned that they would eventually develop symptoms from that slow of a heart rate. Symptomatic slow heart rate ("bradycardia," from the Greek roots) is a clear indication for a permanent pacemaker, and extreme bradycardia (below 40) gets most cardiologists concerned enough to start thinking about a pacemaker even without symptoms.
In your husband's case, if his heart rate were to prove too slow, his cardiologist would likely reduce the dose of the metoprolol, or even switch it out for a different drug.
DEAR DR. ROACH: I am an 86-year-old man in pretty good health. I ran my entire life, including 10K and 10-mile races until my left hip was replaced three times. Is there any documented health benefit from taking 250 steps per hour (that's the minimum on my smartwatch) daily? I am no longer doing duration exercises such as walking. — D.M.
ANSWER: Any exercise is better than none. If you are taking 250 steps for every hour you're awake, that's 4,000 steps per day, which is a lot better than some other people get. You don't need 10,000 steps a day to get benefit.
The running and other exercises you did have been part of the reason you have enjoyed mostly good health until age 86.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.