From the Guidelines
Metoprolol is effective in lowering blood pressure, as evidenced by its ability to reduce morbidity and mortality in patients with hypertension and heart failure 1.
Mechanism of Action
Metoprolol belongs to a class of medications called beta-blockers, which work by blocking the effects of adrenaline on the heart, causing it to beat more slowly and with less force. This reduces the amount of blood pumped through the vessels with each beat, thereby lowering blood pressure.
Dosage and Administration
Metoprolol is typically prescribed at starting doses of 25-100 mg daily, often divided into two doses, with gradual increases as needed. The extended-release form (Toprol XL) can be taken once daily, usually in the morning. Common dosages range from 50-400 mg daily depending on the condition being treated and individual response.
Efficacy and Safety
Studies have shown that metoprolol, along with other beta-blockers such as carvedilol, bisoprolol, and nebivolol, can reduce mortality and morbidity in patients with heart failure 1. The use of metoprolol in patients with hypertension and heart failure is supported by strong evidence, including the Metoprolol CR/XL Randomized Intervention Trial in Heart Failure (MERIT-HF) and the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial 1.
Side Effects and Precautions
Side effects of metoprolol may include fatigue, dizziness, and slow heartbeat. Metoprolol should not be stopped suddenly as this can worsen heart conditions; dosage should always be tapered under medical supervision. It's essential to take metoprolol consistently at the same time each day for maximum effectiveness, and blood pressure should be monitored regularly to ensure the medication is working properly.
Clinical Considerations
The choice of beta-blocker may depend on individual patient characteristics, such as the presence of diabetes or chronic obstructive pulmonary disease. However, metoprolol remains a viable option for the treatment of hypertension, particularly in patients with heart failure, due to its established efficacy and safety profile 1.
From the FDA Drug Label
In controlled clinical studies, metoprolol has been shown to be an effective antihypertensive agent when used alone or as concomitant therapy with thiazide-type diuretics, at oral dosages of 100 to 450 mg daily In controlled, comparative, clinical studies, metoprolol has been shown to be as effective an antihypertensive agent as propranolol, methyldopa, and thiazide-type diuretics, to be equally effective in supine and standing positions
Metoprolol lowers blood pressure. It has been shown to be an effective antihypertensive agent in controlled clinical studies, both alone and in combination with other medications, at dosages of 100 to 450 mg daily 2.
From the Research
Effectiveness of Metoprolol in Lowering Blood Pressure
- Metoprolol has been shown to be effective in lowering blood pressure in patients with mild to moderate hypertension 3.
- A study comparing the antihypertensive efficacy of lisinopril and metoprolol found that both drugs were effective in reducing diastolic blood pressure in patients with moderate to severe hypertension, with no significant difference between the two 4.
- Another study found that fixed-dose combinations of metoprolol and amlodipine were effective and safe in treating mild to moderate hypertension, with significant reductions in blood pressure observed in all treatment groups 5.
- However, a more recent study found that metoprolol did not result in a significant drop in blood pressure compared to no treatment in patients with severe inpatient hypertension, whereas IV hydralazine and oral hydralazine did result in significant reductions in blood pressure 6.
- A study investigating the effects of different antihypertensive drug combinations on blood pressure and arterial stiffness found that various combinations, including those with metoprolol, were effective in reducing blood pressure and improving arterial stiffness, but metoprolol was not specifically highlighted as a key component of these combinations 7.
Key Findings
- Metoprolol is generally effective in lowering blood pressure in patients with mild to moderate hypertension.
- The effectiveness of metoprolol in severe inpatient hypertension is less clear, with one study suggesting it may not be as effective as other treatments.
- Combination therapies, including those with metoprolol, can be effective in reducing blood pressure and improving arterial stiffness.