^^ Is the orthostatic hypotension side effect of propanolol really that bad?
The only beta blockers I've taken are Metoprolol Succinate (Toprol extended release) and Nebivolol (Bystolic), which are selective for the beta1 receptors in the heart (cardioselective), whereas propanolol (Inderal) is nonselective, making it better suited as an antihypertensive rather than a physical anxiety drug.
I prefer metoprolol, as the succinate formulation lasts all day with the one dose, which is quite a feat with beta blockers, as most of the good ones (cardioselective) don't have a half life longer than 5-10 hours. Having a beta blocker be active for roughly 24 hours after a one-off prn dosing, say, for a panic attack, it prevents rebound hypertension. If you're taking a beta blocker just for HBP, though, then a short half life is acceptable when taking it twice a day.
One thing I really like about Metoprolol Succinate is that it's a tablet than can be easily cut (it's scored down the middle), despite being extended release; there is no XR mechanism, rather, the succinate preparation makes it release a lot slower than its tartrate (Toprol) preparation. I usually take 10-12.5mg of Metoprolol from the 50mg succinate tablets, any more than that and the beta blocker side effects (depression, poor blood flow, physical fatigue, and shortness of breath during strenous activities) start becoming too prominent, so I can't imagine the nasty feeling one would get from dosing 200-400mg of metoprolol/day for hypertension.
I am thinking that maybe alpha agonists might be better for treating physical anxiety? Does anyone have any experience with Guanfacine extended release (Tenex)? Guanfacine seems to have less side effects than the superpotent clonidine, especially less fatigue and cognitive impairment.