From the Guidelines
Metoprolol dosing for hypertension should be initiated at 100-200 mg daily for metoprolol tartrate or 50-200 mg daily for metoprolol succinate, with a daily frequency of 1-2 times, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1.
Key Considerations
- The dose can be adjusted based on patient response and tolerance, with a maximum daily dose of 200-400 mg for metoprolol tartrate or 200 mg for metoprolol succinate.
- Metoprolol succinate is preferred in patients with heart failure with reduced ejection fraction (HFrEF) 1.
- It is essential to avoid abrupt cessation of metoprolol, as this can cause rebound hypertension; instead, the medication should be tapered over 1-2 weeks when discontinuation is necessary.
Important Details
- Metoprolol works by blocking beta-1 adrenergic receptors in the heart, reducing heart rate and cardiac output, which lowers blood pressure.
- Patients should be monitored regularly for heart rate and blood pressure during dose adjustments.
- Common side effects of metoprolol include fatigue, dizziness, and bradycardia, which often improve with continued use or dose adjustment.
Special Populations
- For elderly patients or those with hepatic impairment, starting doses should be lower and adjusted carefully based on patient response and tolerance.
- Metoprolol should be taken consistently with respect to meals, as food can affect absorption.
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
The recommended dosing for metoprolol in the treatment of Hypertension (HTN) is 100 to 450 mg daily 2.
- The dosing can be used alone or as concomitant therapy with thiazide-type diuretics.
- Oral dosages of metoprolol have been shown to be effective in controlled clinical studies.
From the Research
Metoprolol Dosing for Hypertension
- The recommended dosing for metoprolol in the treatment of hypertension is not explicitly stated in the provided studies, but we can look at the dosages used in the studies to get an idea of the typical dosing range.
- In the study 3, the starting dosage of metoprolol was 100 mg twice daily, and the dosage was increased at fortnightly intervals until satisfactory blood pressure control was achieved or a total of 400 mg metoprolol was reached. The average dosage of metoprolol required was 200 mg daily.
- The study 3 also compared once-daily and twice-daily administration of metoprolol and found that both regimens were effective in controlling blood pressure.
- The other studies provided do not specifically address the dosing of metoprolol for hypertension, but they do discuss the use of beta-blockers, including metoprolol, in the treatment of hypertension and other cardiovascular conditions.
- The study 4 mentions that metoprolol is one of the beta-blockers that has been shown to be effective in reducing all-cause death in patients with heart failure, but it does not provide information on dosing for hypertension.
- The studies 5 and 6 discuss the use of beta-blockers, including atenolol, in the treatment of hypertension, but they do not provide specific information on the dosing of metoprolol.
Key Points
- Metoprolol is a beta-blocker that can be used to treat hypertension.
- The typical dosing range for metoprolol in hypertension is not explicitly stated in the provided studies, but a starting dosage of 100 mg twice daily, with increases as needed, has been used in some studies.
- Both once-daily and twice-daily administration of metoprolol have been shown to be effective in controlling blood pressure.
- Beta-blockers, including metoprolol, have been shown to be effective in reducing cardiovascular events and mortality in certain patient populations, but the optimal dosing and patient selection for metoprolol in hypertension are not well established in the provided studies.