Effect of controlled-release metoprolol on blood pressure and exercise heart rate in hypertension: a comparison with conventional tablets

In a double-blind study with parallel groups a new controlled-release (CR) formulation of metoprolol, 100 mg once daily, was compared with conventional metoprolol tablets, 100 mg once daily, in 27 patients with primary hypertension. Exercise tests on a bicycle ergometer were undertaken 24 h after intake of the last dose of the drug following a four-week placebo run-in period and after four weeks of active treatment. Heart rate, measured in the supine position and during exercise at the highest comparable workload, was reduced significantly more by metoprolol CR (p less than 0.05), thus indicating a higher degree of beta 1-blockade at the end of the dose interval with metoprolol CR. There was a greater reduction in supine systolic pressure (p less than 0.05) but not in supine diastolic pressure after metoprolol CR than after conventional tablets at 24 h. There was no significant difference between the two groups with respect to reduction in systolic blood pressure during exercise. The 24-h plasma concentrations of metoprolol CR and conventional tablets correlated with the effects on heart rate, but not with blood pressure. The tolerability of metoprolol CR was comparable with that of metoprolol administered as conventional tablets. In conclusion, there was significantly greater beta 1-blockade 24 h after the intake of drug after metoprolol CR compared with conventional tablets.