Metoprolol Dosing and Management for Hypertension

Initial Dosing and Titration

The American Heart Association recommends starting metoprolol tartrate at 25-50 mg twice daily, with titration up to a maximum of 200 mg daily as needed for blood pressure control, according to the American College of Cardiology 1
The initial dose for metoprolol succinate (extended-release) is 50 mg once daily, as suggested by the American Heart Association 2, 1

The dose should be increased gradually every 1-2 weeks if blood pressure control is not achieved, with a target blood pressure reduction of at least 20/10 mmHg, ideally to 140/90 mmHg, as recommended by the American Heart Association 1, 3
The maximum daily dose is 200 mg for metoprolol tartrate and 400 mg for metoprolol succinate, according to the American College of Cardiology 1
Monitoring should include blood pressure and heart rate at each visit, as well as watching for signs of worsening heart failure or bronchospasm, particularly during initiation, as suggested by the American Heart Association 1

Beta blockers, such as metoprolol, are not recommended as first-line agents for hypertension unless the patient has ischemic heart disease or heart failure, according to the American Heart Association 2
Absolute contraindications include signs of heart failure, low output state, increased risk for cardiogenic shock, PR interval >0.24 seconds, second or third-degree heart block, and active asthma or reactive airways disease, as stated by the American College of Cardiology 1
Avoid abrupt cessation of therapy to prevent rebound hypertension, as recommended by the American Heart Association 1