An outpatient who has chronic heart failure returns after 2 weeks of therapy with metoprolol. Which assessment finding is most important to report to the health care provider?

• A. 2+ pedal edema
• B. Heart rate of 56 beats/minute
• C. Blood pressure of 88/42 mm Hg
• D. Complaints of fatigue

Answer: (C)

The key concept is that beta-blockers like metoprolol lower both heart rate and blood pressure. In heart failure, you monitor for hypotension because very low blood pressure can mean poor organ perfusion and may require stopping or lowering the dose.

Reporting a blood pressure of 88/42 mm Hg is the most important finding. That level indicates significant hypotension and potential compromised perfusion to the brain, kidneys, and other organs, which needs urgent assessment and possible adjustment of therapy.

A heart rate of 56 beats per minute shows bradycardia, which can occur with beta-blockers, but it is less alarming than profound hypotension unless the patient has symptoms like dizziness or syncope. Moderate pedal edema is common in chronic heart failure and fatigue, while uncomfortable but nonspecific, is not as immediately risky as a sudden drop in blood pressure.

So, the priority is to report the very low blood pressure to the healthcare provider promptly to determine whether to hold or adjust the medication and investigate causes of the hypotension.