Efficacy and Safety of Different Doses of Metoprolol in the Treatment of Primary Hypertension: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

XIA Zhuqing ,  DONG Birong

Department of Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

DONG Birong, Email: birongdong@hotmail.com

Keywords：

Metoprolol; Primary hypertension; Efficacy; Safety; Systematic review; Randomized controlled trial

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Objective　 To evaluate the efficacy and safety of different doses of metoprolol in the treatment of primary hypertension.
Methods　 We searched for randomized controlled trials of different doses of metoprolol in the treatment of primary hypertension. We screened relevant studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by using The Cochrane Collaboration’s Revman 4.2.8 software.
Results　 Five randomized controlled trials of different doses of metoprolol in the treatment of primary hypertension were included. Two were of high quality and the other three were of low quality. No study reported mortality or the incidence of cardiovascular events, but four studies reported the means and standard deviations of systolic and diastolic blood pressures and heart rate. Based on the two self-control studies, meta-analyses of the levels of systolic and diastolic blood pressures before and after treatment of different doses of metoprolol showed that the combined OR for systolic blood pressure levels was -4.62 [95%CI (-7.77, -1.47), P=0.004]; and for the diastolic blood pressure levels, the combined OR was -5.71 [95%CI (-6.75, -4.68), P lt;0.000 01]. Four studies reported adverse reactions, and meta-analysis of the incidence of non-specific adverse reactions showed that the combined OR was 2.61 [95%CI (1.33, 5.13), P=0.005].
Conclusion　 A dose-effect relationship may exist between the dose of metoprolol and antihypertensive effect in the treatment of hypertension. When the antihypertensive effect of low-dose metoprolol was inadequate, an increase in the dose may lower blood pressure further. Although high-dose metoprolol has higher incidence of adverse reactions, it can be tolerated by most patients. Therefore, in the treatment of hypertension with metoprolol, an individualized dosing regimen can be applied according to the patient’s tolerance, and blood pressure may be controlled ideally by a gradual increase of the metoprolol dose to its maximum tolerated dose.

Citation： XIA Zhuqing,DONG Birong. Efficacy and Safety of Different Doses of Metoprolol in the Treatment of Primary Hypertension: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2007, 07(11): 802-809. doi: Copy

1.	Gu FS. Progress on diagnosis and treatment of hypertension. Chinese Journal of Practical Internal Medicine, 2000, 20(1): 4.
2.	Wang W, Liu LS. The relationship between blood pressure level and cerebral stroke recurrence—four-year follow up of 1520 patients with cerebrovascular diseases. Chinese Journal of Hypertension, 2003, 11: 106-108.
3.	Wang W, Ma LY, Liu MB. Antihypertensive therapy is the key to prevent cardiovascular disease—a retrospective analysis of 29 randomized controlled trials. Chinese Journal of Medical Guide, 2004, 6(4): 259-261.
4.	MOH, MOST, NBS. Survey on nutrition and health status of Chinese residents in 2002. Beijing: People’s Medical Publishing House, 2005. 1-25.
5.	Liu M, Liu GP, Qi J. Metoprolol in the treatment of primary hypertension (210 cases report). Hainan Medical Journal, 2006, 17(11): 76.
6.	Jin T. Common adverse reaction caused by metoprolol— nervous system symptom. Capital Medicine, 2006, 6: 31-32.
7.	Chinese committee on guide of hypertension prevention and treatment. The guidelines for prevention and treatment of hypertension in China (revised edition 2005). Chinese Journal of Hypertension, 2005, 134(Suppl): 2-41.
8.	顾复生. 高血压病诊断治疗的最新进展.中国实用内科杂志, 2000, 20(1): 4.
9.	Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet, 1990, 335: 827-839.
10.	王文, 刘力生. 血压水平与脑卒中再发的关系—1520例脑血管病患者随访4年. 高血压杂志, 2003, 11: 106-108.
11.	王文, 马丽媛, 刘明波. 降低血压水平是预防心脑血管事件的关键——29项随机对照降压临床试验回顾分析. 中国医药导刊, 2004, 6(4): 259-261.
12.	卫生部, 科技部, 国家统计局. 中国居民营养与健康状况调查报告2002. 北京: 人民卫生出版社, 2005. 1-25.
13.	刘敏, 刘光平, 祁健. 美托洛尔治疗原发性高血压210例临床观察. 海南医学, 2006, 17(11): 76.
14.	Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet, 1999, 354: 1896-1900.
15.	Bengtsson C. The effect of metoprolol-a new selective adrenergic β1-receptor blocking agent in mild hypertension. Acta med scand, 1976, 199: 65-70.
16.	Karlberg BE, Nilsson O. Once-daily metoprolol in primary hypertension. Clin Pharmacol Ther, 1979, 25(4): 399-407.
17.	Asplund J, Ohman P. Metoprolol administered once daily in the treatment of hypertension. Annals of Clinical Research, 1981, 13(Suppl 30): 30-36.
18.	Martin A, Browning RC. Metoprolol in the aged hypertensive: a comparison of two dose schedules. Postgraduate Medical Jorunal, 1985, 61: 225-227.
19.	Feliciano N, Kasarjian PH. Safety and tolerability of metoprolol OROS in hypertension treatment. American Heart Journal, 1990, 490-494.
20.	靳婷. 美托洛尔常见不良反应—神经系统症状. 首都医药, 2006, 6: 31-32.
21.	中国高血压防治指南修订委员会. 中国高血压防治指南(2005年修订版). 高血压杂志, 2005, 134(增刊): 2-41.
22.	Julie A, Johnson B, Robert N. Racial differences in adrenoceptor medinated responsiveness. Journal of Cardiovascular Pharmacology, 1995, 25(1): 90-96.

1. Gu FS. Progress on diagnosis and treatment of hypertension. Chinese Journal of Practical Internal Medicine, 2000, 20(1): 4.
2. Wang W, Liu LS. The relationship between blood pressure level and cerebral stroke recurrence—four-year follow up of 1520 patients with cerebrovascular diseases. Chinese Journal of Hypertension, 2003, 11: 106-108.
3. Wang W, Ma LY, Liu MB. Antihypertensive therapy is the key to prevent cardiovascular disease—a retrospective analysis of 29 randomized controlled trials. Chinese Journal of Medical Guide, 2004, 6(4): 259-261.
4. MOH, MOST, NBS. Survey on nutrition and health status of Chinese residents in 2002. Beijing: People’s Medical Publishing House, 2005. 1-25.
5. Liu M, Liu GP, Qi J. Metoprolol in the treatment of primary hypertension (210 cases report). Hainan Medical Journal, 2006, 17(11): 76.
6. Jin T. Common adverse reaction caused by metoprolol— nervous system symptom. Capital Medicine, 2006, 6: 31-32.
7. Chinese committee on guide of hypertension prevention and treatment. The guidelines for prevention and treatment of hypertension in China (revised edition 2005). Chinese Journal of Hypertension, 2005, 134(Suppl): 2-41.
8. 顾复生. 高血压病诊断治疗的最新进展.中国实用内科杂志, 2000, 20(1): 4.
9. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet, 1990, 335: 827-839.
10. 王文, 刘力生. 血压水平与脑卒中再发的关系—1520例脑血管病患者随访4年. 高血压杂志, 2003, 11: 106-108.
11. 王文, 马丽媛, 刘明波. 降低血压水平是预防心脑血管事件的关键——29项随机对照降压临床试验回顾分析. 中国医药导刊, 2004, 6(4): 259-261.
12. 卫生部, 科技部, 国家统计局. 中国居民营养与健康状况调查报告2002. 北京: 人民卫生出版社, 2005. 1-25.
13. 刘敏, 刘光平, 祁健. 美托洛尔治疗原发性高血压210例临床观察. 海南医学, 2006, 17(11): 76.
14. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet, 1999, 354: 1896-1900.
15. Bengtsson C. The effect of metoprolol-a new selective adrenergic β1-receptor blocking agent in mild hypertension. Acta med scand, 1976, 199: 65-70.
16. Karlberg BE, Nilsson O. Once-daily metoprolol in primary hypertension. Clin Pharmacol Ther, 1979, 25(4): 399-407.
17. Asplund J, Ohman P. Metoprolol administered once daily in the treatment of hypertension. Annals of Clinical Research, 1981, 13(Suppl 30): 30-36.
18. Martin A, Browning RC. Metoprolol in the aged hypertensive: a comparison of two dose schedules. Postgraduate Medical Jorunal, 1985, 61: 225-227.
19. Feliciano N, Kasarjian PH. Safety and tolerability of metoprolol OROS in hypertension treatment. American Heart Journal, 1990, 490-494.
20. 靳婷. 美托洛尔常见不良反应—神经系统症状. 首都医药, 2006, 6: 31-32.
21. 中国高血压防治指南修订委员会. 中国高血压防治指南(2005年修订版). 高血压杂志, 2005, 134(增刊): 2-41.
22. Julie A, Johnson B, Robert N. Racial differences in adrenoceptor medinated responsiveness. Journal of Cardiovascular Pharmacology, 1995, 25(1): 90-96.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Different Doses of Metoprolol in the Treatment of Primary Hypertension: A Systematic Review

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