title: Effects of metoprolol CR/XL on mortality and hospitalizations in patients with heart failure and history of hypertension.
abstract: BACKGROUND
  We describe the effect of controlled-release/extended-release (CR/XL) metoprolol succinate once daily on mortality and hospitalizations among patients with a history of hypertension complicated by chronic systolic heart failure.
  
  
  RESULTS
  We enrolled 3,991 patients with chronic heart failure of New York Heart Association functional class II-IV with an ejection fraction of < or = 0.40, stabilized with optimum standard therapy, in a double-blind randomized placebo-controlled study. A total of 1,747 patients (44%) had a history of hypertension; 871 were randomized to receive metoprolol CR/XL and 876 to receive placebo. Treatment with metoprolol CR/XL compared with placebo resulted in a significant reduction in total mortality (relative risk [RR], 0.61; 95% confidence interval [CI], 0.44-0.84; P =.0022), mainly because of reductions in sudden death (RR, 0.51; 95% CI, 0.33-0.79; P =.0022) and mortality from worsening heart failure (RR, 0.49; 95% CI, 0.25-0.99; P =.042). Total number of hospitalizations for worsening heart failure was reduced by 30% in the metoprolol CR/XL group compared with placebo (P =.015). Metoprolol CR/XL was well tolerated: 12% fewer patients withdrew from study medication (all-cause) compared with placebo (P =.048).
  
  
  CONCLUSIONS
  A subgroup analysis of MERIT-HF shows that patients with heart failure and a history of hypertension received a similar benefit from metoprolol CR/XL treatment as all patients included in the total study.
authors.affiliation: Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
authors.forename: John
authors.initials: J
authors.lastname: Wikstrand
authors.forename: Marty
authors.initials: M
authors.lastname: Denny
authors.forename: Paul
authors.initials: P
authors.lastname: Fenster
authors.forename: Thomas
authors.initials: T
authors.lastname: Heywood
authors.forename: Gabriella
authors.initials: G
authors.lastname: Masszi
authors.forename: Sten
authors.initials: S
authors.lastname: Rasmussen
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Thorgeirsson
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D008875:Middle Aged
chemical_list: D000319:Adrenergic beta-Antagonists; D008790:Metoprolol