Current guidelines for β-adrenoblockers use in cardiovascular diseases: focus on metoprolol succinate CR/XL: A review

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Abstract

The objective of this review was to systematize current data on the β-adrenoblockers (β-ABs) used in the treatment of cardiovascular diseases and to analyze the results of studies performed with a focus on metoprolol succinate controlled release/extended release (CR/XL) formulation. The article addresses issues related to pharmacological features of metoprolol succinate CR/XL, the use of β-AB in arterial hypertension, coronary heart disease, chronic heart failure, and cardiac arrhythmias based on international and Russian clinical guidelines. Results of randomized clinical trials evaluating the efficacy of metoprolol succinate CR/XL are presented. In preparing the literature review, a review of publications over the past 34 years in the MEDLINE/PubMed, Scopus, Cochrane Library, eLIBRARY, and Google Scholar databases was performed. The presented data indicate the need for more extensive use of β-ABs, including metoprolol succinate CR/XL, in clinical practice.

About the authors

Marina G. Bubnova

National Medical Research Center for Therapy and Preventive Medicine

Author for correspondence.
Email: mbubnova@gnicpm.ru
ORCID iD: 0000-0003-2250-5942

D. Sci. (Med.), Prof.

Russian Federation, Moscow

References

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2. Fig. 1. The concentration of metoprolol in blood plasma within 24 hours after a single dose of the drug at a dose of 100 mg in the form of conventional (immediate) release and in the form CR/XL (adapted [4]).

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3. Fig. 2. Plasma drug concentrations over 24 hours of metoprolol succinate CR/XL at a dose of 100 mg and bisoprolol at a dose of 10 mg after a single dose (adapted [8]).

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4. Fig. 3. Dynamics (∆, ±95% CI, mmHg) of systolic blood pressure within 24 hours (according to 24-hour blood pressure monitoring) after a single dose of metoprolol succinate CR/XL at a dose of 100 mg and bisoprolol at a dose of 10 mg (adapted [8]).

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5. Fig. 4. BCAPS: effect of metoprolol CR/XL therapy for 36 months on the combined endpoint of cardiovascular events (myocardial infarction and stroke) and all deaths (Kaplan–Meier curves); adapted [35].

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6. Fig. 5. MERIT-HF study: hospitalization rates in the metoprolol succinate CR/XL and placebo groups in patients with and without diabetes mellitus (adapted from [55]).

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7. Fig. 6. The MERIT-HF study: the incidence of carbohydrate metabolism-related side effects in patients with diabetes mellitus and the incidence of new cases of diabetes mellitus (adapted from [38]).

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