Metoprolol dose
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Metoprolol Dose: Efficacy and Safety in Various Conditions
Metoprolol Dose in Hypertension
Efficacy of Metoprolol in Primary Hypertension
Metoprolol, a selective beta-1 adrenoceptor blocker, has been shown to effectively reduce blood pressure in patients with primary hypertension. In a study involving 32 patients, doses of 150 mg and 300 mg once daily were evaluated. The results indicated that 40% of patients on 150 mg and 71% on 300 mg experienced a significant reduction in mean arterial pressure (≥10% over placebo)1. The antihypertensive effect was sustained for up to 26 hours post-dose, with heart rates reduced except in the standing position1.
Dose-Response Relationship in Hypertensive Patients
Further research on hypertensive patients receiving metoprolol at doses ranging from 25 mg to 150 mg thrice daily showed a significant reduction in systolic blood pressure and pulse rate. However, the response varied significantly among individuals, indicating a need for personalized dosing6. Additionally, a study on the kinetics and dose-response characteristics of metoprolol revealed that doses above 200 mg/day did not significantly enhance the antihypertensive effect, suggesting a relatively flat dose-response curve at higher doses10.
Metoprolol in Heart Failure
Metoprolol CR/XL in Chronic Heart Failure
The Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) demonstrated that metoprolol CR/XL significantly reduced all-cause mortality in patients with chronic heart failure. Patients were initially given 12.5 mg or 25 mg once daily, with the dose titrated up to 200 mg once daily. The study found a 34% reduction in relative risk of all-cause mortality and significant decreases in sudden deaths and deaths from worsening heart failure2 9.
Dose Titration and Clinical Outcomes
A post-hoc analysis of the MERIT-HF trial indicated that both high-dose (mean 192 mg) and low-dose (mean 76 mg) groups experienced similar reductions in total mortality compared to placebo. This suggests that individualized dose titration based on patient tolerability and heart rate response is effective8.
Metoprolol in Pediatric Hypertension
Efficacy and Safety in Children
In a clinical trial involving hypertensive children aged 6 to 16 years, extended-release metoprolol succinate (ER metoprolol) was administered at doses of 0.2 mg/kg, 1.0 mg/kg, and 2.0 mg/kg. The study found significant reductions in systolic and diastolic blood pressure at the 1.0 mg/kg and 2.0 mg/kg doses compared to placebo, with no serious adverse events reported3. This indicates that ER metoprolol is both effective and well-tolerated in pediatric patients.
Metoprolol in Vasovagal Syncope
Prevention of Syncope
The Prevention of Syncope Trial (POST) assessed the efficacy of metoprolol in preventing vasovagal syncope. Patients received doses ranging from 25 mg to 200 mg daily. The study concluded that metoprolol was not effective in reducing the risk of recurrent syncope, regardless of patient age or initial tilt-test results5.
Conclusion
Metoprolol is a versatile beta-blocker with proven efficacy in managing hypertension and chronic heart failure. The optimal dose varies based on the condition being treated, patient age, and individual response. While higher doses may offer greater benefits in some cases, personalized dosing regimens based on patient tolerability and heart rate response are crucial for maximizing therapeutic outcomes.
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Most relevant research papers on this topic
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.
RCTEffect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in-Congestive Heart Failure (MERIT-HF)
Metoprolol CR/XL once daily in addition to standard therapy improved survival in chronic heart failure patients with decreased ejection fraction and symptoms, and was well-tolerated.
RCT
Large Human Trial
Highly CitedEfficacy 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 CitedPlasma 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 CitedPrevention of Syncope Trial (POST): A Randomized, Placebo-Controlled Study of Metoprolol in the Prevention of Vasovagal Syncope
Metoprolol was not effective in preventing vasovagal syncope in the study population.
RCTHighly CitedPlasma 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.
RCTBeneficial effects of metoprolol in idiopathic dilated cardiomyopathy
Metoprolol treatment prevents clinical deterioration, improves symptoms and cardiac function, and is well-tolerated in patients with idiopathic dilated cardiomyopathy.
RCTLarge Human TrialHighly CitedDose of metoprolol CR/XL and clinical outcomes in patients with heart failure: analysis of the experience in metoprolol CR/XL randomized intervention trial in chronic heart failure (MERIT-HF).
Metoprolol CR/XL reduces mortality risk similarly in high- and low-dose subgroups, supporting an individualized dose-titration regimen based on patient tolerability and heart rate response.
RCTLarge Human TrialHighly CitedMetoprolol
Metoprolol CR/XL effectively decreases mortality and improves clinical status in patients with stable mild to moderate chronic heart failure due to left ventricular systolic dysfunction, and is effective in patients with ischaemic or dilated cardiomyopathy.
RCTMetoprolol 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