### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am 64 years old. Despite a low risk profile: no familial history of heart issues, don t smoke, exercise regularly, good diet, no fat around girth, cholesterol in the normal desirable range, and normal blood pressure, two years ago i experienced severe chest pains which resulted in me having a stent installed in one artery. The others were clear. I was prescribed: Perindopril 2mg Atorvastatin 20mg Asprin 75mg Sometimes, I suspect my blood pressure may be a little low, although when my GP checks it routinely on my occasional visits it has been normal. Recently, I sensed my blood sugar was a little low and perhaps combined with low blood pressure, I experienced some worrying memory disturbance, which however, resolved within a couple of hours. I consulted a doctor about this but with inconclusive outcome. I have since been fine and back to functioning with full cognitive capacity (I work in the mental health field). I have also experience for some time now low libido, and occasional problems with mild impotence. Also, my doctor diagnosed me with benign tremor, which again is mild, and at this stage not too noticeable. My question is: could changing my medication address these issues better? I m wondering if nebivolol (given the good data on it now and its superiority over other beta blockers for heart conditions) could be used to replace perindopril, slightly lowering my blood pressure, and perhaps helping the benign tremor. I am aware that it is the only beta blocker of its kind that has been found not associated with a decline in libido and the problem of impotence. My last cardiologist in Australia suggested that perindopril was best for me because of its specific properties relative to my condition. I am wondering if this is the case now in the light of new data on the effectiveness of nebivolol. Lastly, I have not felt fully myself ever since the stent was installed and I started on the medications, despite daily exercise, excellent diet, meditation, and no alcohol. I forgot to mention, my cholesterol is now sitting around 3 (it never did exceed 4.5 even before I commenced on atorvastatin). Because I am in the UK getting sound advice without waiting many weeks is frustrating. Hope I can receive good advice, that will improve my quality of life and give me the very best prognosis given my history.

### output:

Hi, Nevibilol and perindopril belong to two different class of blood pressure medication had its own benefit and side effect profile.  As per my understanding, there are certain aspects of why you want to shift to Nevibilol. Let me explain each.  1) Fall in pressure, maybe titration of perindopril dose would be more appropriate. Decreasing the same may help. 2) Tremors, Nevibilol is a beta blocker with intrinsic sympathetic activity, so though beta blocker as a class helps reduce essential tremors, Nevibilol may not help much.3) Libido, though Nevibilol is marketed as causing the least loss in libido, for sure it doesn't improve it.  Also, it's a company-sponsored trial, so how much to rely on is a problem.  Lastly, Perindopril has never been associated with loss of libido, so your problem may be completely unrelated and so changing medication may not make that big a difference.  For sure Nevibilol is heart protective but so is Perindopril. So I think your doctor would be in the best position to select which medication would be best considering your individual characteristics. Hope I have answered your query. Let me know if I can assist you further.