Objective To systematically review the effectiveness and safety of carvedilol and metoprolol for primary hypertension. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were electronically searched for relevant studies from inception to December, 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria as well as the methods recommended by the Cochrane Collaboration, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results 7 trials involving 2 243 patients were included. The results of meta-analysis showed no significant difference in the reduction of systolic blood pressure, diastolic blood pressure, and heart rate between the carvedilol and metoprolol groups (Pgt;0.05). However, the carvedilol group was superior to the metoprolol group in improving serum triglyceride (MD=0.75, 95%CI 0.45 to 1.04, Plt;0.000 01), serum cholesterol (MD=0.38, 95%CI 0.19 to 0.56, Plt;0.000 1), serum low density lipoprotein (MD=0.59, 95%CI 0.33 to 0.85, Plt;0.000 01), serum high density lipoprotein (MD= –0.09, 95%CI –0.16 to –0.02, P=0.008), and fasting plasma glucose (MD=0.36, 95%CI 0.21 to 0.51, Plt;0.000 01). In addition, the incidence of drug related adverse reaction was significantly lower in the carvedilol group (OR=0.39, 95%CI 0.24 to 0.63, P=0.000 1). Conclusion Based on current evidence, carvedilol tends to have beneficial effects on metabolic parameters and safety profiles, compared with metoprolol.
Objective According to health technology assessment (HTA) methodology, to assess the efficacy and safety of different doses of metoprolol in the treatment of atrial fibrillation (AF). Methods Based on the principles of HTA, we searched some important medical databases including MEDLINE, EMBASE, The Cochrane Library and CMCC, as well as several national special heart disease databases and side effect centers. We selected eligible studies based on the inclusion and exclusion criteria and critically assessed their quality. Results Intravenous metoprolol 10 mg - 15 mg could control rapid ventricular rate in patients with chronic AF. On either rest or exercise, oral metoprolol 150 mg/d had a better control of rapid ventricular rate than 50 mg/d in patients with chronic AF. For preventing postoperative AF (POAF), the intravenous metoprolol 20 mg group and the 30 mg group could decrease the incidence of POAF compared to the 10 mg group. Oral metoprolol 150 mg/d was more effective than 100 mg/d in preventing POAF. In addition, intravenous metoprolol therapy was well-tolerated and more effective than oral metoprolol therapy in preventing atrial fibrillation after cardiac surgery. Results from several national side effect centers demonstrated that the incidence of adverse reactions associated with metoprolol was low. Conclusion Present evidence showed that high dose of metoprolol was superior to low dose in treating AF, however, the evidence available is insufficient. It is suggested that adequate evidence through further studies are needed. The safety profile of different doses of metoprolol is similar.
Objective To access the efficacy and safety of different doses of metoprolol for patients with chronic heart failure. Methods We searched databases such as MEDLINE, EMbase, The Cochrane Library, CBM and CMCC. The search was conducted in March 2006. Randomised controlled trials, systematic reviews, and current guidelines of chronic heart failure were reviewed. The efficacy and safety of the high-dose (≥100 mg/d) and low-dose metoprolol (lt;100 mg/d) were compared. Results Only one small-scale, short-term randomised trial met our inclusion criteria. This found that metoprolol 100 mg/d was more effective than 25 mg/d and 50 mg/d. A sub-group analysis of MERIT-HF recommended individualized titration for drug administration. Most guidelines suggested that the administration of metoprolol CR/XL for chronic left ventricular systolic dysfunction should be performed by titrating up to 200 mg/d or the maximum tolerance dose. Patients receiving 100 mg/d might have more adverse events than those receiving a lower dose than this. However, in the long-term, it’s the benefits of high-dose treatment outweighed its risks. Race-related differences in tolerance or dose-related adverse effects were not found. Conclusion We couldn’t determine an optimal dose based on the existing evidence, but a target dose of metoprolol CR/XL 200 mg/d is safe and effective. We are unable to draw any conclusions about the relationship between dose and adverse effects.
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), Plt;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.
ObjectiveTo explore the effects of metoprolol on hemodynamics of early septic shock patients with myocardial injury. MethodsWe prospectively recruited 22 septic shock patients with myocardial injury, who were admitted to the ICU of Xiaolan Hospital during March 2014 and February 2015.The metoprolol was injected through central venous catheter to reduce heart rate by 20% from baseline and maintain for 6h.Hemodynamic and oxygen metabolic parameters were collected to establish database. ResultsHeart rate decreased significantly to (98±18), (95±16) and (92±18) beat/min respectively at 1h, 3h and 6h post-dosing, compared with (125±28) beat/min at pre-dosing (P < 0.05).Cardiac index decreased significantly to (3.2±1.5), (3.3±1.9) and (3.3±1.6) L·min-1·m-2 respectively at 1h, 3h and 6h post-dosing, compared with (3.9±2.5) L·min-1·m-2 at pre-dosing (P < 0.05).The mean blood pressure, central venous pressure, pulmonary artery wedge pressure, pulmonary vascular resistance index, systemic vascular resistance index and stroke volume index showed no significant changes between pre-dosing and post-dosing (all P > 0.05). Lactate concentration decreased significantly to (9.8±4.1) and (8.1±3.6)mmol/L respectively at 3h and 6h post-dosing, compared with (13.4±5.2)mmol/L at pre-dosing (all P < 0.05), but mixed venous oxygen saturation showed no significant changes (P > 0.05). ConclusionMetoprolol may reduce heart rate and cardiac output in septic shock patients with myocardial injury, without obvious adverse effects on circulatory function and systemic perfusion.
ObjectiveTo systematically review the efficacy of irbesartan combined with metoprolol plus conventional treatment compared with single drug (irbesartan, metoprolol) plus conventional treatment or conventional treatment for elderly patients with severe heart failure.MethodsPubMed, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on irbesartan combined with metoprolol in the treatment of elderly patients with severe heart failure from January 2009 to September 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Network meta-analysis was then performed using gemtc package of R software.ResultsA total of 58 RCTs involving 5 064 patients were included. The results of meta-analysis showed that the efficiency, left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) of combination group were significantly superior to single drug group.ConclusionsThe current evidence shows that under the premise of conventional treatment, the combination of irbesartan and metoprolol is more effective than irbesartan or metoprolol alone in the treatment of elderly patients with severe heart failure. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.