How much does metoprolol (beta blocker) lower blood pressure?

From the Guidelines

Metoprolol typically lowers blood pressure by about 10-15 mmHg systolic and 8-10 mmHg diastolic when used at therapeutic doses. The medication is usually started at 25-50 mg twice daily for immediate-release formulations or 50-100 mg once daily for extended-release versions, with doses gradually increased as needed to a maximum of 200-400 mg daily depending on patient response 1. The full blood pressure lowering effect generally takes 1-2 weeks to develop. Metoprolol works by blocking beta-1 adrenergic receptors primarily in the heart, reducing heart rate and cardiac output, which leads to decreased blood pressure. The medication also reduces the release of renin from the kidneys, further contributing to its antihypertensive effect.

Some key points to consider when using metoprolol for blood pressure management include:

• The medication should be used with caution in patients with certain medical conditions, such as heart failure or asthma 1.
• Individual responses to metoprolol can vary based on factors like age, weight, concurrent medications, and overall health status.
• Side effects may include fatigue, dizziness, and bradycardia, so blood pressure and heart rate should be monitored regularly after starting treatment or adjusting doses.
• In patients with resistant hypertension, metoprolol may be used in combination with other medications, such as ACE inhibitors or calcium channel blockers, to achieve better blood pressure control 1.

It's worth noting that while metoprolol is effective in lowering blood pressure, other beta blockers like carvedilol may be more effective in certain patient populations, such as those with heart failure 1. However, metoprolol remains a commonly used and effective medication for blood pressure management.

From the Research

Effects of Metoprolol on Blood Pressure

• Metoprolol, a beta blocker, has been shown to lower blood pressure in patients with essential hypertension 2, 3, 4, 5.
• The mean decrease in blood pressure during treatment with metoprolol was 24 +/- 3.8/10 +/- 2.1 mm Hg in the lying position and 23 +/- 4.4/9 +/- 3.1 mm Hg after 1 min in the standing position 2.
• In another study, 60% to 85% of patients achieved a diastolic blood pressure of 12 kPa (90 mmHg) or lower during the 12-week trial 3.
• The maximum effect of metoprolol on blood pressure occurred after approximately three weeks 3.
• The mean reductions in supine blood pressure were 26/15 and 16/9 mm Hg in the metoprolol and propranolol groups, respectively, after 36 weeks' treatment 4.

Dose-Response Relationship

• The dose of metoprolol varied from 25 mg to 400 mg/day, with the majority of patients achieving controlled mild to moderate hypertension with 100 mg twice a day 3.
• The individual changes in mean blood pressure did not correlate with either the premetoprolol PRA level or the changes in PRA after metoprolol, but did correlate with steady-state metoprolol plasma levels 5.

Patient Response

• Normotension (diastolic pressure less than 90 mm Hg) or reduction in diastolic pressure of at least 10 mm Hg was achieved in 12 of the 20 patients 1 week after metoprolol was added to the hydrochlorothiazide regimen 5.
• Asthmatics and diabetics tolerated metoprolol extremely well, indicating the clinical importance of metoprolol's cardioselectivity 3.