Reviews of metoprolol
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Reviews of Metoprolol: Efficacy and Applications
Metoprolol in Chronic Heart Failure
Mortality Reduction and Clinical Improvement
Metoprolol, particularly in its controlled-release/extended-release (CR/XL) form, has shown significant benefits in patients with chronic heart failure. The MERIT-HF trial demonstrated a 34% reduction in all-cause mortality among patients with stable, mild to moderate chronic heart failure (NYHA class II to III) when treated with metoprolol CR/XL. This reduction was attributed to decreases in sudden death and death due to progressive heart failure. Similarly, the RESOLVD pilot study observed a trend towards decreased mortality in the metoprolol group compared to placebo. These findings underscore metoprolol's role in improving survival and clinical status in heart failure patients.
Functional and Quality of Life Improvements
Patients treated with metoprolol CR/XL or immediate-release metoprolol also experienced significant improvements in NYHA functional class, exercise capacity, and some measures of quality of life compared to placebo. These benefits were observed when the drug was initiated at low dosages and gradually increased, highlighting the importance of careful dose titration.
Metoprolol in Acute Myocardial Infarction
Mortality and Morbidity Outcomes
The MIAMI trial investigated the effects of metoprolol in patients with acute myocardial infarction (AMI). Although the overall reduction in mortality was not statistically significant, a subset of high-risk patients showed a 29% reduction in mortality with metoprolol treatment. Additionally, metoprolol significantly reduced the incidence of supraventricular tachyarrhythmias and the need for pain-relieving treatment, indicating its potential benefits in managing post-AMI complications.
Ventricular Tachyarrhythmias
In a separate study, metoprolol was found to significantly reduce the occurrence of ventricular fibrillation in patients with suspected myocardial infarction. This prophylactic effect against severe ventricular arrhythmias further supports the use of metoprolol in the acute phase of myocardial infarction.
Metoprolol in Chronic Obstructive Pulmonary Disease (COPD)
Exacerbation and Hospitalization Risks
A randomized trial assessing metoprolol's effects on COPD patients found no significant difference in the time until the first exacerbation between the metoprolol and placebo groups. However, metoprolol was associated with a higher risk of exacerbation leading to hospitalization, raising concerns about its safety in this patient population. These findings suggest that metoprolol may not be beneficial for COPD patients without an established indication for beta-blocker use.
Metoprolol in Hypertension and Angina Pectoris
Efficacy and Tolerability
Metoprolol has been widely used in the treatment of mild to moderate hypertension and angina pectoris. It has been shown to be as effective as other beta-blockers, diuretics, and certain calcium antagonists in managing these conditions. The drug is generally well tolerated, with common side effects including temporary fatigue, dizziness, and headache. Metoprolol's beta1-selectivity may also make it suitable for patients with conditions like asthma and diabetes, where non-selective beta-blockers are contraindicated.
Metoprolol in Idiopathic Dilated Cardiomyopathy
Survival and Cardiac Function
Several studies have highlighted the benefits of metoprolol in patients with idiopathic dilated cardiomyopathy. Long-term treatment with metoprolol has been associated with improved survival, reduced clinical deterioration, and enhanced cardiac function . Patients treated with metoprolol showed significant improvements in ejection fraction, exercise capacity, and symptoms, indicating its efficacy in managing this condition .
Hemodynamic and Energetic Benefits
Metoprolol has also been shown to improve myocardial performance and energetics in patients with nonischemic dilated cardiomyopathy. The drug enhances left ventricular performance and efficiency without increasing myocardial oxygen consumption, suggesting increased myocardial efficiency. These hemodynamic and energetic benefits further support the use of metoprolol in treating myocardial failure.
Conclusion
Metoprolol has demonstrated significant benefits across various cardiovascular conditions, including chronic heart failure, acute myocardial infarction, hypertension, angina pectoris, and idiopathic dilated cardiomyopathy. While its use in COPD remains controversial due to safety concerns, metoprolol's efficacy in improving survival, clinical status, and cardiac function in other conditions is well established. Careful dose titration and patient selection are crucial to maximizing its therapeutic benefits.
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