What is the dose of metoprolol (beta blocker) for hypertension (HTN)?

From the Guidelines

For the treatment of hypertension, metoprolol tartrate is recommended at a dose of 100-200 mg twice daily, while metoprolol succinate is recommended at a dose of 50-200 mg once daily. The dosage of metoprolol for hypertension can vary depending on the specific formulation used 1. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline, metoprolol tartrate can be administered at a dose of 100-200 mg twice daily, and metoprolol succinate can be administered at a dose of 50-200 mg once daily 1.

Key Considerations

• The dose can be gradually increased every 1-2 weeks based on blood pressure response.
• The usual maintenance dose is 100-200 mg daily, with a maximum recommended daily dose of 400 mg.
• Metoprolol works by blocking beta-1 adrenergic receptors in the heart, reducing heart rate and contractility, which lowers blood pressure.
• When initiating therapy, monitor blood pressure and heart rate regularly, and be aware of potential side effects including fatigue, dizziness, and bradycardia 1.

Special Populations

• Dose adjustments may be needed for elderly patients or those with liver impairment.
• Metoprolol should be taken consistently at the same time each day, and patients should never abruptly discontinue the medication as this can cause rebound hypertension or other cardiac events 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 The dose of metoprolol for hypertension (HTN) is 100 to 450 mg daily.

• The dosage can be administered alone or as concomitant therapy with thiazide-type diuretics.
• The effective dosage range is based on controlled clinical studies 2.

From the Research

Metoprolol Dosage for Hypertension

• The dosage of metoprolol for hypertension can vary, but studies have shown that 100 mg and 200 mg once daily can effectively lower blood pressure over a 24-hour period 3.
• A study comparing atenolol and metoprolol found that metoprolol 100 mg/day and 200 mg/day in a sustained-release formulation had some limitations in controlling systolic blood pressure and heart rate, but doses smaller than those recommended were almost as effective and much cheaper 4.
• Another study found that beta-blockers, including metoprolol, were relatively ineffective in lowering systolic blood pressure in elderly patients with essential hypertension, and had more side effects compared to other antihypertensive drugs 5.

Comparison with Other Antihypertensive Drugs

• A study comparing the effectiveness of different antihypertensive drugs found that diuretics and calcium-blocking drugs were more effective in lowering systolic blood pressure in elderly patients, while beta-blockers were relatively ineffective 5.
• A fixed-dose ACE inhibitor-diuretic combination was found to be more effective in reducing ambulatory blood pressures and arterial stiffness in isolated systolic hypertension compared to antihypertensive monotherapy 6.
• The choice of antihypertensive drug should be based on individual patient characteristics, such as the presence of heart failure, chronic kidney disease, or diabetes mellitus 7.