My mother had a center brain bleed stroke 6 months ago. She’s been on metoprolol.25mg for about 6 years but she said she only took it when she had heart palpitations because a previous cardiologist said she had afib. The new cardiologist said she does not have afib. He did say that she needs a pacemaker because her heart rate is so low. I informed him that at the time she was also taking keppra and clonazapam which also lower her heart rate. He then changed his mind about the pacemaker. Her BP has been high at night and the valsartan is long acting and takes a while to work. After I did extensive research I talked with her primary about stopping metoprolol and adding something faster for the extremely high nightly BP. After I checked all interactions I found that clonodine has the least side effects and will work faster than the valsartan. Can the metoprolol be stopped immediately or does it need to be tapered? Her heart rate is usually in the mid 50’s while her BP at night and early morning can reach up to 210/110 and has required multiple trips to the ER.