What is the role of Metoprolol in managing hypertension?

From the Guidelines

Metoprolol plays a crucial role in managing hypertension, particularly in patients with heart failure or coronary artery disease.

Key Points

• Metoprolol is a beta-blocker that lowers blood pressure and alleviates ischemia and angina 1.
• The Metoprolol CR/XL Randomized Intervention Trial in Heart failure (MERIT-HF) showed a 34% reduction in mortality in patients with heart failure 1.
• Metoprolol is recommended for the long-term management of patients with hypertension-related left ventricular systolic dysfunction 1.
• The usual dose of metoprolol succinate is 50-200 mg once daily 1.
• Metoprolol should be used with caution in patients with severe hypertension or ongoing ischemia, and the initiation of therapy should be delayed until stabilization has been achieved in hemodynamically unstable patients 1.
• Beta-blockers, including metoprolol, are not recommended as first-line agents for hypertension unless the patient has ischemic heart disease or heart failure 1.
• Metoprolol may be less effective than other antihypertensive agents, such as calcium antagonists and RAS blockers, in preventing stroke and regressing left ventricular hypertrophy 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

The role of Metoprolol in managing hypertension is as an effective antihypertensive agent. It can be used alone or in combination with other medications, such as thiazide-type diuretics, at a daily oral dosage of 100 to 450 mg. Metoprolol has been shown to be as effective as other antihypertensive agents, including propranolol and methyldopa, in controlling blood pressure in both supine and standing positions 2.

From the Research

Role of Metoprolol in Managing Hypertension

• Metoprolol is a beta 1-selective adrenoceptor antagonist that is widely used in the treatment of mild to moderate hypertension 3, 4, 5, 6, 7.
• The drug has been shown to be at least as effective as other beta-blockers, diuretics, and certain calcium antagonists in reducing blood pressure in hypertensive patients 3, 4, 6.
• Optimum treatment of hypertension with metoprolol is achieved through dose titration within the therapeutic range, and a twice daily dosage regimen is normally used, although satisfactory control can be maintained in many patients with single daily doses of conventional or slow release formulations 3, 4.
• The addition of a diuretic may improve the overall response rate in hypertension, and metoprolol is generally well tolerated, with temporary fatigue, dizziness, and headache being among the most frequently reported side effects 3, 6.

Pharmacoeconomic and Quality-of-Life Evaluation

• Metoprolol has been shown to have beneficial effects on morbidity and mortality in hypertensive patients, and controlled release formulations offer the potential to maximize the antihypertensive benefits of metoprolol 4.
• Pharmacoeconomic analysis indicates that metoprolol is more cost-effective than high-dose thiazide diuretics in middle-aged men with mild to moderate hypertension, although the advantage for beta-blockade is not supported by results of other studies 4.
• Quality of life in patients with mild to moderate hypertension did not deteriorate in most investigations with metoprolol, and was similar to that with atenolol, although differences in quality of life between metoprolol and other antihypertensive agents appear to be marginal 4.

Clinical Experience and Recommendations

• Extensive clinical experience on metoprolol has been gained in different cardiovascular conditions, including heart failure, ischemic artery disease, arterial hypertension, and atrial fibrillation 7.
• Metoprolol still appears to be a suitable pharmacological option in different cardiovascular conditions, and research on this molecule is still active, with new, promising settings of use being explored 7.