Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Clinical and clinicoeconomical studies review is presented as well as results of author’s comparative cost analysis on metoprolol tartrate (Betaloc) and metoprolol succinate (Betaloc ZOK) usage in patients with ischemic heart disease. Efficacy of metoprolol therapy is proven in randomized clinical studies in patients with angina and myocardial infarction (MI). In angina patients metoprolol prevents cardiac attacks, MI, reduces nitroglycerine consumption, increases exercise tolerability, prolongs the exercise time before ST segment depression (succinate better than tartrate), decrease of angina intensity. In MI patients metoprolol therapy reduces mortality, sudden death, recurring MI and the rate of early post MI angina attacks. Nowadays metoprolol is the only β-blocker having indication on secondary MI prevention. Besides for the present metoprolol succinate is the only β-blocker with proven direct antisclerosis effect. According to Swedish clinicoeconomical study in patients after MI secondary prevention with metoprolol therapy saves the costs in comparison with placebo. American clinicoeconomical model of metoprolol and atenolol usage in all patients with MI could result in significant reduction in mortality and recurring MI rate, prolong the life and improve its quality, save financial resources. The cost of monthly treatment of angina patient with metoprolol tartrate (Betaloc) and metoprolol succinate (Betaloc ZOK) is 135 and 354 rubles, respectively. The price range of comparative β-blockers in ascending order is the following: atenolol (Atenolol Nicomed) → metoprolol tartrate (Betaloc) → metoprolol succinate (Betaloc ZOK) → bisoprolol (Concor) → nebivolol (Nebilet). In conclusion, metoprolol therapy is the one of mostly economically reasonable approach.

About the Author

M. V. Soura
Research Institute of Public Health and Health Services management, Moscow Medical Academy named after I.M. Setchenov. Zubovsky Blvd 37/1, Moscow, 119021 Russia
Russian Federation
Department of Public Health Standardization



1. Терещенко С.Н., Косицина И.В., Джаиани Н.А. Все ли мы знаем об особенностях метопролола в лечении ишемической болезни сердца? Кардиология 2005;45(4):98-101.

2. Yusuf S., Peto R., Lewis J. et al. Beta-blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985;27:335-71.

3. Gottlieb S., McCarter R., Vogel R. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med. 1998;339(8):489-97.

4. Lubsen J., Tijssen J.G. Efficacy of nifedipine and metoprolol in the early treatment of unstable angina in the coronary care unit: findings from the Holland Interuniversity Nifedipine/metoprolol Trial (HINT). Am J Cardiol 1987;60:18A-25A.

5. Ardissino D., Savonitto S., Egstrup K., et al. Selection of medical treatment in stable angina pectoris: results of the International Multicenter Angina Exercise (IMAGE) study. J Am Coll Cardiol 1995;25:1516-21.

6. Egstrup K., Gundersen T., Härkönen R., et al. The antianginal efficacy and tolerability of controlled-release metoprolol once daily: a comparison with conventional metoprolol tablets twice daily. Eur J Clin Pharmacol 1988;33:Suppl:S45-9.

7. Gardtman M., Dellborg M., Brunnhage C. et al. Effect of intravenous metoprolol before hospital admission on chest pain in suspected acute myocardial infarction. Am Heart J 1999;137:821-9.

8. Hjalmarson A, Herlitz J, Holmberg S, et al. The Goteborg metoprolol trial. Effects on mortality and morbidity in acute myocardial infarction. Circulation 1983;67(6 Pt 2):I26-32.

9. Metoprolol in acute myocardial infarction (MIAMI): A randomized placebo–controlled international trial. The MIAMI Trial Research Group. Eur Heart J 1985;6:199-226.

10. Roberts R., Rogers W.J., Mueller H.S. et al. Immediate versus deferred beta-blockade following thrombolytic therapy in patients with acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI) II–B Study. Circulation 1991;83:422-37.

11. Olsson G, Rehnqvist N. Reduction of nonfatal reinfarctions in patients with a history of hypertension by chronic postinfarction treatment with metoprolol. Acta Med Scand. 1986;220(1):33-8.

12. Portegies MC, Sijbring P, Göbel EJ, et al. Efficacy of metoprolol and diltiazem in treating silent myocardial ischemia. Am J Cardiol. 1994;74(11):1095-8.

13. Poulsen SH, Jensen SE, Egstrup K. Improvement of exercise capacity and left ventricular diastolic function with metoprolol XL after acute myocardial infarction. Am Heart J. 2000;140(1):E6-11.

14. Hedblad B., Wikstrand J., Janzon L. et al. Low dose metoprolol CR/XL and fluvastatin slow progression of carotid intima-media thickness: main results from the Beta-Blocker Cholesterol-Lowering Asymptomatic Plaque Study (BCAPS). Circulation 2001;103:1721- 6.

15. Wiklund O., Hulthe J., Wikstrand J. et al. Effect of controlled release/extended release metoprolol on carotid intima-media thickness in patients with hypercholesterolemia: a 3-year randomized study. Stroke 2002;33:572-7.

16. Phillips K A, Shlipak M G, Coxson P, et al. Health and economic benefits of increased beta-blocker use following myocardial infarction. JAMA. 2000;284(21):2748-54.

17. Olsson G, Levin L-A, Rehnqvist N. Economic consequences of postinfarction prophylaxis with beta blockers: cost effectiveness of metoprolol. Br Med J (Clin Res Ed). 1987;294:339-42.

For citation:


Views: 1683

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)