Is metoprolol (beta-blocker) used as a preventive medication for hypertension or diabetes in the absence of cardiovascular implications, similar to Angiotensin Receptor Blockers (ARBs) or Angiotensin-Converting Enzyme inhibitors (ACE inhibitors)?

From the Guidelines

Metoprolol is not typically used as a first-line preventive medication for hypertension or diabetes in the absence of cardiovascular implications, unlike ARBs or ACE inhibitors. Beta-blockers like metoprolol are generally reserved for patients who have specific cardiovascular conditions such as coronary artery disease, heart failure, or previous myocardial infarction, where they provide significant benefits beyond blood pressure control 1. For uncomplicated hypertension without cardiovascular disease, guidelines typically recommend starting with thiazide diuretics, calcium channel blockers, ACE inhibitors, or ARBs as first-line agents. These medications have better evidence for reducing cardiovascular events and mortality in patients with uncomplicated hypertension. Some key points to consider include:

• The use of ACE inhibitors or ARBs is recommended for individuals with diabetes and established coronary artery disease, or for those with albuminuria to reduce the risk of progressive kidney disease 1.
• Beta-blockers like metoprolol have not been shown to reduce mortality as blood pressure–lowering agents in the absence of specific cardiovascular conditions such as prior MI, active angina, or HFrEF 1.
• Metoprolol also doesn't offer the kidney-protective effects that ACE inhibitors and ARBs provide for diabetic patients, which is why these latter medications are preferred for hypertensive diabetic patients. Key differences between beta-blockers and other antihypertensive medications include their effects on cardiovascular outcomes and mortality, as well as their potential metabolic effects, such as an increased risk of developing diabetes or worsening glycemic control in diabetic patients.

From the Research

Metoprolol as a Preventive Medication

• Metoprolol, a beta-blocker, is not typically used as a preventive medication for hypertension or diabetes in the absence of cardiovascular implications, unlike Angiotensin Receptor Blockers (ARBs) or Angiotensin-Converting Enzyme inhibitors (ACE inhibitors) 2, 3.
• ACE inhibitors have been shown to delay the onset and slow the progression of diabetic nephropathy, independent of blood pressure effects 2.
• Beta-blockers, including metoprolol, are generally used to treat hypertension, angina, and heart failure, rather than as a primary preventive measure for atherosclerosis or cardiovascular disease 4, 5.

Comparison with ARBs and ACE Inhibitors

• ARBs and ACE inhibitors are commonly used to treat hypertension and have been shown to have renoprotective effects, reducing the risk of diabetic nephropathy and slowing the progression of kidney disease 2, 3.
• Metoprolol, on the other hand, is often used as an adjunct therapy to ACE inhibitors or ARBs in patients with hypertension and diabetes, particularly in those with symptomatic angina or heart failure 6, 4.

Potential Benefits of Beta-Blockers

• Newer beta-blockers, such as metoprolol, have been shown to have neutral or favorable effects on lipoprotein levels and glucose metabolism, which may make them a useful component of combination regimens for preventing atherosclerosis and cardiovascular disease 5.
• However, further research is needed to establish the potential benefits of beta-blockers in preventing atherosclerosis and cardiovascular disease, particularly in combination with other established treatments 5.