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CLINICAL STUDIES

Hemodynamic comparison of twice daily metoprolol tartrate with once daily metoprolol succinate in congestive heart failure

^a Heart Failure Program, Cardiovascular Institute, Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA

Manuscript received February 25, 1999; revised manuscript received July 9, 1999, accepted September 21, 1999.

Reprint requests and correspondence: Marrick Kukin, Cardiovascular Institute, Department of Medicine, Box 1030, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, New York 10029
marrick.kukin{at}mssm.edu

OBJECTIVES

To compare the hemodynamic effects of twice daily metoprolol tartrate (MT) and once daily metoprolol succinate (MS) in congestive heart failure patients.

BACKGROUND

Adverse hemodynamic effects with MT demonstrated during initiation persist with drug readministration during chronic therapy.

METHODS

Patients were randomly assigned to 6.25 mg MT or 25 mg MS orally and the dose was gradually increased to a target of 50 mg twice a day or 100 mg once a day, respectively. Hemodynamic measurements were obtained at baseline and after three months of therapy—both before and after drug readministration.

RESULTS

Long term metoprolol therapy produced significant functional, exercise and hemodynamic benefits with no difference in response between either metoprolol preparation in the 27 patients (MT [14], MS [13]). When full dose metoprolol was readministered during chronic therapy, there were parallel adverse hemodynamic effects in both drug groups. Cardiac index decreased by 0.6 liters/min/m² (p < 0.0001) with MT and by 0.5 liters/min/m² (p < 0.0001) with MS. Systematic vascular resistance increased by 253 dyne-sec-cm^–5 (p < 0.001) with MT and by 267 dyne-sec-cm^–5 (p < 0.0005) with MS. Stroke volume index decreased by 7.0 ml/m² (p < 0.0005) with MT and by 6.5 ml/m² (p < 0.0001) with MS, while SWI decreased by 6.2 g-m/m² (p < 0.0005) with MT and by 6.0 g-m/m² (p < 0.001) with MS.

CONCLUSION

Metoprolol tartrate and MS produce similar hemodynamic and clinical effects acutely and chronically despite the fourfold greater starting dose of MS used in this study. A more rapid initiation with readily available starting doses of MS may offer distinct advantages compared with MT in treating chronic heart failure patients with beta-adrenergic blocking agents.

Abbreviations and Acronyms   b.i.d. = twice a day   CI = cardiac index   MERIT-HF = Metoprocol Randomized Intervention Trial   MS = metoprolol succinate   MT = metoprolol tartrate   NYHA = New York Heart Association   PCW = pulmonary capillary wedge pressure   q.d. = every day   SVI = stroke volume index   SVR = systemic vascular resistance   SWI = stroke work index

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