Was on metoprolol xr 100 and lasix 80 upon discharge from hospital. cardiologist reduced lasix to 40 for maintenance dosage but bp at night higher. will a second 50 mg dose of metoprolol help? consider nitrates due to acr/arb restriction (low gfr)?

Discuss with your MD: There can be a lot of ramifications to your health with changing dosagea. This is something you need to discuss with your physicians. It would not be wise for us to recommend that you change your medications.

Hypertension: Of course your cardiologist is best qualified to advise you as he/she knows all your findings. However in my opinion I would be averse to increasing metoprolol or lasix, (furosemide) but instead add a calcium channel blocker like amlodipine which wouldn't lower your heart rate or lower your GFR.

On hiB/P meds: Changing doses of your B/P meds will probably change your B/P. Discuss it with your doc and get a home B/P monitor so you can see how things are going even when your not at the docs office.

Uncontrolled HTN: Addition of metoprolol might help but Cardiac functional status and the heart rate need to be in consideration. How low the GFR decides whether ACE or ARB could be used. Whether there is ischemia decides the need for nitrates, so need to consider several factors to choose the medicine, may be another class what you have not mentioned is the choice for you, so talk to your physician who knows you

Changing medication: It is most advisable for you to consult with your cardiologist concerning your problem and if any change in medication is necessary

Metoprolol xl: Metoprolol xl is given once a day, though you can have doses >100 . But you have a cardiologist so it is best to discuss the situation with them , they should be directing your care. Nitrates are usually for angina care but there are other hypertensive categories , calcium channel blockers, alpha blocker,s mixed blockers, alpha 2 adrenergic receptor agonists, discuss with your cardiologist

Follow up with MD: see your doctor for follow up and meds adjustment may need to consider another agent for BP control