Introduction
One of the most often prescribed pharmacological classes in clinical practice is beta-adrenergic blocking medicines or beta-blockers. They act as antagonists that compete with catecholamines to block their binding to adrenergic receptors. Their initial application in clinical practice was for the management of angina pectoris and essential hypertension. Over time, beta-blockers have also become more clinically relevant for the treatment of arrhythmias and congestive heart failure (Saheera et al., 2018). Although all of these substances block adrenergic receptors pharmacologically, each has unique pharmacological characteristics. The use of metoprolol to treat coronary heart disease and hypertension is discussed in this paper, along with the nursing and therapeutic ramifications.
Hypertension
The disease known as hypertension occurs when small blood vessels in the body start to constrict, which pushes the heart to work harder to keep the pressure constant. The main determinants of blood pressure levels are typically cardiac output, peripheral vascular resistance, circulating blood volume, blood viscosity, and vessel wall flexibility (Katsi et al., 2019). When a person has hypertension, their blood pressure is always excessively high, which has an impact on all variables. Metoprolol’s mechanism of action enables the heart to beat more slowly and reduces blood pressure under these circumstances. As a result, the heart receives more blood and oxygen as blood pressure decreases.
Despite its benefits, metoprolol is not a frontline treatment. Beta-blockers are the third therapeutic option for treating hypertension that can be utilized in clinical practice, according to the most recent US and UK recommendations (Grassi, 2018). However, it is widely used due to its advantages and relative easiness of employment. Additionally, metoprolol is less likely to cause airway narrowing. Since the middle of the 1970s, there has been a substantial body of research and clinical data supporting the use of metoprolol in the treatment of hypertension (Saheera et al., 2018). In-depth analyses of the drug’s effectiveness and tolerability in comparison to other popular antihypertensive medications were released at the same time. Unlike coronary artery disease treatment, alpha-methyldopa, thiazide diuretics, ACE inhibitors, and calcium channel blockers have all been contrasted with metoprolol (Grassi, 2018). Overall, these trials’ findings demonstrated metoprolol’s effectiveness in comparison to the reference medications under study.
The advantage of metoprolol over diuretic treatment for preventing coronary events in individuals at high risk of cardiovascular hypertension was shown in a trial of metoprolol for the prevention of atherosclerosis in patients with arterial hypertension in the late 1980s (Grassi, 2018). Additionally, a lot of well-conducted research has been done over the years to examine possible variations in clinical effectiveness, cardio-metabolic effects, organ protection, and tolerance amongst various beta-blockers. Metoprolol is used as the primary treatment for hypertension as a result of several studies. In a Metoprolol Atherosclerosis Prevention in Hypertensives study using metoprolol for patients with arterial hypertension in the late 1980s, the benefit of metoprolol medication over diuretic therapy for preventing coronary events was demonstrated (Katsi et al., 2019). Furthermore, a great deal of rigorous research has been done over the years to investigate potential differences in the clinical efficacy, cardio-metabolic consequences, organ protection, and tolerance across distinct beta-blockers.
Coronary Artery Disease
Coronary artery disease is caused by plaque accumulation on the arterial walls supplying blood to the heart. Chest pain can be brought on by decreased blood supply to the heart, although a heart attack is the condition’s main risk factor (Grassi, 2018). The justification for using beta-blockers after receiving therapy for coronary heart disease is complex. Similar to hypertension, myocardial infarction can benefit from pharmaceutical blockage of cardiac beta-adrenergic receptors because it affects left ventricular remodeling, systolic function, and myocardial post-necrotic inflammatory response (Saheera et al., 2018). Therefore, the current ESC guidelines for the diagnosis and handling of stable coronary artery disease include metoprolol (Saheera et al., 2018). Similarly, with hypertension, beta-blockers should also be the first-line antianginal therapy in patients with stable coronary artery disease who have no contraindications to this treatment, according to the most recent ESC guidelines. Even though it is not a frontline treatment currently, beta-blockers can quickly lower blood pressure and lessen the severity and frequency of angina, which lowers the risk of heart disease, heart attacks, and stroke.
Metoprolol usage decreased the requirement for higher dosages of other heart failure medications and decreased the frequency of hospitalizations for heart failure exacerbations. It also often caused symptoms to improve more frequently, increased ejection fraction, and increased physical activity duration (Katsi et al., 2019). Improvements in symptoms, left ventricular function, exercise duration, and risk of a severe exacerbation were seen with long-term beta-blocker medication.
Implications and Outcomes
The key implication is that this beta-blocker seems to be crucial for medical practice since there are still a few other options with the same efficiency available. As for the therapeutic outcomes, the current research on the subject is ambivalent; however, unified in terms of the importance of metoprolol in both cases. The potential adverse outcomes have been highlighted several times, but these outcomes can be lessened by combinations of different treatment cycles (Grassi, 2018). The administration of metoprolol, as well as patient education, should continue to develop to facilitate the research on the topic and its potential implications for nurses and therapists. Cardiovascular damage prevention or reversal is the primary objective of antihypertensive therapy. Similarly, patients with coronary heart disease are treated with the intention of symptom relief and future heart issues like unstable angina.
In connection with these implications and outcomes, it is important to highlight safety considerations for administering metoprolol in nursing settings. Patients with bradycardia, second or third-degree heart blocks or high systolic blood pressure should utilize it with precaution (Katsi et al., 2019). Additionally, dose reduction or an extended-release formulation should be taken into consideration for individuals with known hepatic impairment (Grassi, 2018). It is also important to highlight patient teaching points and nursing implications. In the cases of hypertension and coronary artery disease, the key patient teaching points are patient education and post-rehabilitation control of weight, diet, and blood pressure. As for the nursing implication, pre- and post-assessments are crucial during and after the drug prescription course. When combined, the metoprolol treatment will be beneficial and help to relieve the lives of patients suffering from different conditions.
Conclusion
Despite being available for many years, metoprolol is still used as a topical treatment drug for a variety of cardiovascular disorders. Without a doubt, in view of the most recent ESC recommendations, this chemical is crucial to the management of patients with heart failure. A surprising amount of clinical trial data and, more significantly, real-world circumstances suggest that metoprolol succinate is at least as efficacious as other beta-blockers now used in clinical practice. Additionally, as shown in multiple trials, the effectiveness and safety profile is independent of patient characteristics.
Metoprolol could also work well for treating stable coronary artery disease. Numerous published studies and more than 40 years’ worth of clinical experience support the use of metoprolol succinate in the treatment of arterial hypertension. In conclusion, metoprolol still merits a crucial position as an appropriate pharmacological agent in a variety of cardiovascular disorders. Promising uses are being investigated as part of continuing research on this chemical, which may produce important findings in the upcoming years.
References
Grassi, G. (2018). Metoprolol in the treatment of cardiovascular disease: A critical reappraisal. Current Medical Research and Opinion, 34(9), 1635–1643. Web.
Katsi, V., Scalise, G., Kallistratos, M. S., Tsioufis, K., Makris, T., Manolis, A. J., & Tousoulis, D. (2019). Ivabradine and metoprolol in fixed-dose combination: When, why and how to use it. Pharmacological Research, 146, 104279. Web.
Saheera, S., Potnuri, A. G., & Nair, R. R. (2018). Modulation of cardiac stem cell characteristics by metoprolol in hypertensive heart disease. Hypertension Research, 41(4), 253–262. Web.