Question: Good day doctor. My father-in-law is 83 years old with a history of high blood pressure and sometimes high heart rate. 3 months ago, he had very high blood pressure and felt dizzy. He visited hospital emergency and later discharged with no significant impact. His Rampiril changed to a higher dosage of 10mg after discharge. In addition, He used to take a higher dosage of Ramipril (10mg capsule). Later he suffered from periodic low blood pressure during the day so his cardiologist reduced Ramipril first to 5mg and later on to 2.5mg.

However, he fell recently and the emergency cardiologist suspected that the fall was likely triggered by low blood pressure. As he recovered well, he was discharged from hospital. Emergency cardiologist suggested to reduce his medication so to alleviate high blood pressure. However, the new perscription shows Rmipril jumped up to 10mg instead of going down. but Metoprolol was removed.while Ramipril increased 4 times.

My question - why was Metoprolol removed from his perscription? does removing 2.5mg of Metoprolol justify the significant increase in Ramipril? I would appreciate if you could help me to understand the difference and similiarities between Metoprolol and Ramipril in terms of lowering blood pressure.