Which is better for treating hypertension, metoprolol (beta-blocker) or atenolol (beta-blocker)?

From the Guidelines

Metoprolol is generally considered better than atenolol for treating hypertension. Metoprolol has more favorable pharmacokinetic properties, including better tissue penetration and a more balanced effect on both beta-1 and beta-2 receptors. It comes in immediate-release forms (typically 25-100 mg twice daily) and extended-release formulations (25-200 mg once daily), offering flexible dosing options. Metoprolol has demonstrated superior cardiovascular outcomes in clinical practice and has fewer central nervous system side effects than atenolol, as noted in the 2018 ACC/AHA guideline 1. Additionally, metoprolol's shorter half-life allows for easier dose adjustments and potentially fewer adverse effects if doses are missed. While both medications effectively lower blood pressure, metoprolol also has approved indications for heart failure and post-myocardial infarction patients, making it more versatile for patients with multiple cardiovascular conditions, as discussed in the 2022 study on individualized beta-blocker treatment 1. However, the best choice ultimately depends on individual patient factors including comorbidities, potential drug interactions, and tolerance to side effects.

Some key points to consider when choosing between metoprolol and atenolol include:

• Metoprolol's pharmacokinetic properties and flexible dosing options
• The medications' effects on cardiovascular outcomes and central nervous system side effects
• Individual patient factors, such as comorbidities and potential drug interactions
• The patient's specific cardiovascular conditions, such as heart failure or post-myocardial infarction

It's also important to note that beta-blockers, including metoprolol and atenolol, are not recommended as first-line agents for hypertension unless the patient has specific conditions, such as ischemic heart disease or heart failure, as stated in the 2018 ACC/AHA guideline 1. However, metoprolol's benefits in patients with hypertension and other cardiovascular conditions make it a preferred choice in many cases, as supported by the 2022 study on individualized beta-blocker treatment 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 Atenolol has been studied in combination with thiazide type diuretics, and the blood pressure effects of the combination are approximately additive. The dose range of atenolol is narrow and increasing the dose beyond 100 mg once daily is not associated with increased antihypertensive effect.

Comparing Metoprolol and Atenolol for Hypertension:

• Both metoprolol and atenolol are effective antihypertensive agents.
• Metoprolol has been shown to be as effective as other antihypertensive agents, including propranolol, methyldopa, and thiazide-type diuretics.
• Atenolol's antihypertensive effect is not increased by doses beyond 100 mg once daily.
• No direct comparison between metoprolol and atenolol is provided in the given drug labels to conclusively determine which is better for treating hypertension. 2 3

From the Research

Comparison of Metoprolol and Atenolol

• Both metoprolol and atenolol are beta-blockers used to treat hypertension, but their effectiveness and side effects can vary 4.
• A study published in 2005 found that there is no evidence to suggest that atenolol is better or worse than metoprolol in treating hypertensive patients 4.
• However, metoprolol may be preferred over atenolol for patients with heart failure, as it has been more thoroughly evaluated for this indication 4.

Pharmacological Properties and Therapeutic Efficacy

• Metoprolol is a beta1-selective adrenoceptor blocking drug with a longer duration of effect than expected from its half-life, making it suitable for twice daily administration 5.
• Metoprolol is similar in efficacy to other beta-adrenoceptor blocking drugs in angina pectoris and essential hypertension, and is well tolerated with minimal side effects 5.
• Atenolol, on the other hand, has been shown to have a higher total mortality and stroke risk compared to other antihypertensive agents 4.

Clinical Trials and Studies

• A long-term study of women with arterial hypertension found that metoprolol was effective in controlling blood pressure and was well tolerated 6.
• The Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) trial found that metoprolol CR/XL reduced the risk of all-cause mortality in patients with chronic heart failure 7.
• A comparison of carvedilol and metoprolol found that carvedilol may be superior in improving metabolic situation and preventing secondary disorders caused by diabetes 8.