 This 66-year-old patient has history of hypertension and has not taken medication for several months.  She is a smoker and she drinks alcohol regularly.  She drinks about 5 glasses of wine every day.  Last drink was yesterday evening.  This afternoon, the patient felt palpitations and generalized weakness and came to the emergency room.  On arrival in the emergency room, the patient's heart rate was 121 and blood pressure was 195/83.  The patient received 5 mg of metoprolol IV