Metoprolol dose for hypertension

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Metoprolol Dose for Hypertension: An Overview

Introduction to Metoprolol for Hypertension

Metoprolol, a selective beta-1 adrenergic receptor blocker, is widely used in the management of hypertension. It works by reducing heart rate, cardiac output, and the release of renin from the kidneys, thereby lowering blood pressure. This article synthesizes research findings on the effective dosing of metoprolol for hypertension.

Effective Dosing Regimens

Twice-Daily vs. Once-Daily Administration

Research comparing once-daily and twice-daily administration of metoprolol has shown that both regimens are effective in controlling blood pressure. A study involving 100 hypertensive patients found no significant difference in the reduction of systolic and diastolic blood pressure between once-daily controlled-release (CR) metoprolol and twice-daily conventional metoprolol tablets . Another study confirmed that both dosing schedules significantly reduced blood pressure and heart rate, with no significant difference in efficacy between the two regimens .

Dose-Response Relationship

The dose-response characteristics of metoprolol indicate that doses above 200 mg/day do not significantly enhance the antihypertensive effect. In a study with 34 hypertensive patients, incremental doses between 100 and 600 mg/day resulted in a relatively flat dose-response curve above 200 mg/day . This suggests that increasing the dose beyond 200 mg/day may not provide additional benefits in blood pressure reduction.

Plasma Levels and Blood Pressure Reduction

The relationship between plasma levels of metoprolol and its antihypertensive effects has been studied extensively. One study found that the mean decrease in blood pressure was significant at doses of 25 mg three times daily and 100 mg three times daily, with a notable reduction in both systolic and diastolic blood pressure . However, another study indicated that the antihypertensive effects and side effects did not correlate with plasma metoprolol concentrations .

Special Populations: Children and Adolescents

Extended-release metoprolol succinate has been evaluated for its efficacy and safety in children aged 6 to 16 years with hypertension. The study demonstrated significant reductions in both systolic and diastolic blood pressure at doses of 1.0 mg/kg and 2.0 mg/kg, with no serious adverse events reported . This indicates that metoprolol is a viable option for managing hypertension in pediatric populations.

Conclusion

Metoprolol is an effective and well-tolerated option for managing hypertension. Both once-daily and twice-daily dosing regimens are effective, with no significant difference in their ability to reduce blood pressure. Doses above 200 mg/day do not appear to provide additional benefits, and the drug is also effective in pediatric populations. These findings support the use of metoprolol as a flexible and reliable treatment for hypertension.

Sources and full results

Most relevant research papers on this topic

Plasma levels and effects of metoprolol on blood pressure, adrenergic beta receptor blockade, and plasma renin activity in essential hypertension

Metoprolol effectively reduces blood pressure and plasma renin activity in essential hypertension patients, with varying effects depending on individual factors.

RCTHighly Cited

1976·

78citations

·C. von Bahr et al.

Once‐daily metoprolol in primary hypertension

Once-daily metoprolol effectively reduces blood pressure in primary hypertension patients, with 71% of patients responding to 300 mg dose, and heart rates remain reduced for 26 hours after a 150-mg dose.

RCT

1979·

24citations

·B. Karlberg et al.

Efficacy and safety of extended release metoprolol succinate in hypertensive children 6 to 16 years of age: a clinical trial experience.

Extended release metoprolol succinate is an effective and well-tolerated treatment for hypertension in children aged 6-16 years.

RCTHighly Cited

2007·

70citations

·D. Batisky et al.

Plasma levels and effects of metoprolol on blood pressure and heart rate in hypertensive patients after an acute dose and between two doses during long‐term treatment

Metoprolol effectively reduces systolic blood pressure and heart rate in patients with mild hypertension, with both doses showing a linear relationship to plasma concentrations.

Non-RCTHighly Cited

1975·

121citations

·C. Bengtsson et al.

Plasma levels and effects of metoprolol after single and multiple oral doses

Metoprolol reduces systolic blood pressure and pulse rate after single doses, but diastolic blood pressure does not consistently decrease, and multiple doses' effects cannot be predicted from single dose responses.

RCT

1980·

22citations

·P. Collste et al.

Metoprolol kinetics and dose response in hypertensive patients

Metoprolol kinetics and dose-response characteristics in hypertensive patients vary, with nonlinear kinetics and a relatively horizontal dose-response curve at doses above 200 mg/day.

Non-RCT

1980·

27citations

·M. Myers et al.

A Comparison of a Controlled Release (CR/ZOK) Formulation of Metoprolol, Once Daily, with Conventional Metoprolol Tablets, Twice Daily, in Mild to Moderate Hypertension

Once daily dosing with the new CR/ZOK formulation of metoprolol is as effective as twice daily dosing with conventional metoprolol tablets in reducing mild to moderate hypertension.

RCT

1990·

13citations

·G. Carruthers et al.

Efficacy and tolerability of a new controlled-release formulation of metoprolol: A comparison with conventional metoprolol tablets in mild to moderate hypertension

The new controlled-release metoprolol formulation effectively reduces blood pressure and heart rate in mild to moderate hypertension, with more patients responding to treatment than conventional tablets.

RCT

2004·

9citations

·J. Houtzagers et al.

Exercise blood pressure and heart rate reduction 24 and 3 hours after drug intake in hypertensive patients following 4 weeks of treatment with bisoprolol and metoprolol: a randomized multicentre double-blind study (BISOMET).

Bisoprolol provides a stronger and more persistent reduction in exercise blood pressure and heart rate compared to metoprolol, with 86-93% residual effects after 24 hours.

RCT

1987·

29citations

·R. Haasis et al.

A comparison between once-daily and twice-daily administration of metoprolol in the management of hypertension.

Metoprolol effectively reduces blood pressure and pulse rate in Asian patients with mild to moderate hypertension, with both once-daily and twice-daily administration showing no significant difference in blood pressure control.

RCT

1980·

3citations

·B. Chia

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