infarction is increased for older patients during the first month of withdrawal from cardioselective beta-blockers and Withdrawal symptoms of headache, palpitations, and tremor occurred in one of seven patients after pindolol, six of nine after propranolol, and three of eight after metoprolol. Prescribers are encouraged to use the pharmacological diversity of beta-blockers and the clinical characteristics of patients to individualise treatment and optimise care. bisoprolol may be preferred, Respiratory disease: cardioselective beta-blockers, e.g. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. The primary end points were the mean dynamic HR reduction and the mean dynamic diastolic BP (DBP) control in the last 4 h of the treatment period. Shalansky K, Sunderji R, et al. Copyright 2021 GlobalRPH - Web Development by, Drug Comparisons Beta Blockers equivalent doses, HONcode standard for trust- worthy health, Pediatric Oncology: Diagnosis And Prognosis Communication. Stable angina: management. David McAuley, Pharm.D. Beta blockers can also affect your cholesterol and triglyceride levels. Guidelines support the use of a beta-blocker for one to three years post-myocardial infarction,18, 19 but bpac.org.nz/BPJ/2013/february/managing-heart-failure.aspx. "Bisoprolol" should take it less often than the first. Prescribed for Supraventricular. Secondary end points included ambulatory monitoring of the BP and HR, safety and compliance. post-myocardial infarction is uncertain). Available, http://www.globalrph.com/beta_blockers.htm. An official website of the United States government. Approximately At a molecular level the succinate and tartrate salts of metoprolol are very similar and the active ingredient of the chest pain, even in those with no history of coronary heart disease. No studies have directly compared the blood pressure lowering effects of carvedilol and metoprolol. 40% of reviewers reported a positive effect, while 34% reported a negative effect. The first measured heart rate was used as baseline heart rate. these as the dose is titrated upwards.12 Adverse effects will often resolve and patients can be encouraged Patients from seven centers in China were treated with either bisoprolol 5 mg or metoprolol CR/ZOK 47.5 mg once daily for 12 weeks. New Zealand Formulary (NZF). Metoprolol is a beta-blocker and diltiazem is a calcium channel blocker. Drug Comparisons Beta Blockers - Comparative properties and equivalent dosages of various beta blocker medications and protocols for clinical professionals. The innovator brand (Betaloc) was also heavily marketed in New We have now added the ability to add replies to a comment. beta-blockers, but there is evidence of benefit for a number of other beta-blockers and international guidelines do not atenolol, celiprolol and nadolol; Sotalol. Choosing to participate in a study is an important personal decision. The difference between the mean ABPM observed in the last 24 hours at Week 12 and baseline was calculated to find out the change of mean ABPM at the end of the treatment. Jttel A, Baandrup S, Houtzagers J, Westergren G. J Clin Pharmacol. Nadolol 80mg daily. Doctors usually prescribe beta-blockers to treat cardiovascular conditions such as angina and hypertension, which is also known as high blood pressure. Learn why you might need them and their possible side effects. British Hypertension Society. Secondary end points included ambulatory monitoring of the BP and . Bisoprolol is lipophilic and hydrophilic. . an asthma attack. -, Am J Hypertens. 500 mg QID/q6h. 53 years experience. Bisoprolol & Metoprolol are selective 1 adrenergic blockers used in treatment of several diseases, including hypertension (HTN). The better beta blocker will be the one that works best for you. For example, . it was found that sotalol was associated with a higher rate of sudden death when administered to patients As mentioned, most patients can be initially switched to 6.25 mg or 12.5 mg b.i.d. If the patients blood pressure is on target, and pindolol tend not to be used, Cardioselective beta-blockers, e.g. ACE inhibitors interfere with the conversion of . service delivery areas, and we are recognised nationally and internationally for our expertise and innovation. Read More. 2021 Sep 17. doi: 10.1007/s10557-021-07248-1. This was possibly because of dose optimizations to the highest tolerated beta-blocker dose after carvedilol was switched to bisoprolol. patients received a lower dose of metoprolol (50 mg b.i.d. heart failure.14 Bisoprolol or metoprolol succinate are usually prescribed as they are the most cardioselective Subjects received 10 mg bisoprolol, 50 mg carvedilol, 10 mg nebivolol and . or metoprolol succinate will provide the maximum effect with the minimum amount of adverse effects. Metoprolol (Lopressor)* 2.5 to 5 mg IV bolus over 2 minutes, up to 3 doses . Full Answer. Anti-oxidants help prevent inflammatory conditions and lower blood pressure. Nighttime was defined as 10:00 pm to 06:00 am. Zebeta (Bisoprolol) Prescription only. atenolol, celiprolol or nadolol, are less likely to cause CNS adverse effects, stimulation of the pulmonary beta2-adrenoceptors thus causing bronchoconstriction and reducing the effectiveness The primary end points were the mean dynamic HR reduction and the mean dynamic diastolic BP (DBP) control in the last 4 h of the treatment period. Bisoprolol is preferred as it is more cardioselective than metoprolol Further information on beta-blockers is available in the podcast: the Rational use of beta-blockers with Dr Linda Cardiol. amlodipine. Methods: Therefore, we performed a randomized, double-blind, placebo-controlled, cross-over trial in 16 healthy males. The first measured daytime heart rate was used as baseline heart rate. 19 hours. There are no specific guidelines for withdrawing beta-blockers. Daily. Up to 5 mg, dose to be given at a rate of 1-2 mg/minute, then up to 5 mg after 5 minutes if required, total dose of 10-15 mg. Beta-blockers are the first-line treatment for long-term symptomatic rate control in patients with a range of cardiac Daytime in this study was defined as time between 06:00 am to 10:00 pm. Leafy green vegetables. -Blocker. 3.6 / 5 average rating with 457 reviews forAtenolol. Gynaecology and urinary tract disorders (female), Integrated Performance and Incentive Framework, bpac.org.nz/BPJ/2013/february/managing-heart-failure.aspx, bpac.org.nz/BPJ/2013/August/hypertension.aspx, The optimal duration of treatment 2019 May;21(5):648-657. doi: 10.1111/jch.13543. This website was made to assist in clinical knowledge recall and to supplement and support clinician judgement. review and meta-analysis of randomized controlled trials. I know the Metoprolol seemed like a high dose, but 150mg was in the middle, dosage-wise. Its chemical name is ()1-(isopropylamino)-3-[p-(2-methoxyethyl) phenoxy]-2-propanol succinate (2:1) (salt). Bisoprolol: Dosing of bisoprolol for patients with congestive heart failure is best guided by the CIBIS II dosing protocol. Research is ongoing into the complex ways in which these properties translate into treatment effects for patients. Initially, prescribe 12.5 mg once daily for 2 days, then increase to 25 mg once a day (12.5 mg daily may provide adequate control in elderly people). Available bpac.org.nz/BPJ/2015/April/coronary.aspx, There are two reasons why the optimal duration of beta-blocker treatment post-myocardial infarction is uncertain:16, A systematic review of sixty trials that divided studies into either the reperfusion era or the pre-reperfusion era, -, Cardiovasc Drugs Ther. Weber MA. Record the patients heart rate and blood pressure before treatment is initiated and continue to monitor Unlike to renin-angiotensin system blockers (RAS blockers), only four beta-blockers, i.e., carvedilol, metoprolol succinate, bisoprolol, and nebivolol, have demonstrated a beneficial effect. (if multiple replies to a comment, they will appear in order of submission). Although the trivariable (propensity score/-blocker equivalent dose-adjusted) models found metoprolol succinate to be associated with higher all-cause mortality in younger patients, in nondiabetics, in patients with ischemic cause, in patients with a heart rate 75 per minute, in patients with sinus rhythm, and in those with sinus rhythm . Two different salts are available, metoprolol tartrate and metoprolol Each ABPM lasted for at least 24 hours. However, if you have problems with beta blockers, there are alternative drugs available. m not sure if there is a chart for comparing beta blockers, but as far as I know, bisoprolol (Emconcor) is about 20 times as strong as Metoprolol, so 1,25 mg of bisoprolol is approx. (HF-REF) after a diuretic has reduced the patients fluid overload. It is important, however, not to confuse the different formulations of metoprolol when they are prescribed. failure or arrhythmias, if re-vascularisation has occurred, Bisoprolol is an alternative to metoprolol succinate in many cases; both are once-daily cardioselective beta-blockers See the full pregnancy warnings document. The first measured heart rate was used as baseline heart rate. The ABPM determined blood pressure 3 times hourly in the daytime. weeks 1-8 in total). atenolol, bisoprolol and metoprolol, have a greater affinity for Subjects will receive metoprolol succinate (Betaloc SR) at a dose of 47.5 mg once daily orally as SR tablets for a period of 4 weeks. from: National Institute for Health and Care Excellence (NICE). 1000 mg QID/q6h. View this study on Beta.ClinicalTrials.gov, U.S. Department of Health and Human Services, The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. bisoprolol and metoprolol, Bisoprolol works on heart-specific receptors to lower blood pressure and slow heart rate; however, cardioselectivity may be lost if dosages are greater than 20mg/day. By working on the beta-1 receptor of the cardiac muscle cells, it yields both a chronotropic and inotropic effect. The difference between the last 4 hours heart rate after 12-week treatment and of the baseline heart rate was calculated to measure the change in mean heart rate at the end of the treatment. Weight <85kg, heart failure (50mg total daily), Contraindicated in severe liver impairment. Talk with your doctor and family members or friends about deciding to join a study. N Z Med J 2012;125:12247. When a beta-blocker is initiated, a slow upwards titration of dose is recommended to minimise adverse effects. Pham P. Beta-blockers. Second, a higher proportion of carvedilol users achieved the recommended daily target dose (50 mg; 3124 [52%]) than did metoprolol users (200 mg; 689 [12%]). In conclusion, bisoprolol provided superior dynamic HR reduction and non-inferior dynamic BP reduction vs. metoprolol CR/ZOK in patients with mild-to-moderate hypertension. Atenolol. swelling and fluid retention, along with weight gain. beta1-adrenoceptors and are less likely to cause constriction of airways or peripheral vasculature and are Two measurements were made at least 1 to 2 minutes apart. Two hours after oral administration of the drugs heart rate and blood pressure were measured at rest, after 10 min of exercise, and after 15 min of recovery. A total of 186 patients, with 93 patients in each group, were enrolled and analyzed. A systematic review unique. Causes, symptoms and basic methods of treatment of thrombophlebitis in pregnancy. 2014 Jun;37(6):533-7 emergence of co-morbidities may make management more complex and it is appropriate to periodically review the benefits Medicare statistics. If you have angina or AF, for example, other drugs that slow the heart rate, such as diltiazem or verapamil, may be substituted. Federal government websites often end in .gov or .mil. bisoprolol or metoprolol, are less likely to cause adverse effects, e.g. less than 100 mmHg. Subjects with contraindications according to the China Summary of Product Characteristics (SmPCs) of both bisoprolol and metoprolol SR, such as acute heart failure, second or third degree atrioventricular block (without a pacemaker), sick sinus syndrome, symptomatic bradycardia or symptomatic hypotension, severe bronchial asthma or severe chronic obstructive pulmonary disease, metabolic acidosis, etc. preferred for patients with co-existing chronic obstructive pulmonary disorder (COPD) because they cause less bronchoconstriction, 72% were prescribed metoprolol succinate; the seventh most prescribed medicine in New Zealand, 4% were prescribed carvedilol or propranolol, Reperfusion techniques and the routine use of statins and anti-platelet medicines post-myocardial infarction mean Beta blockers generally arent used in people with asthma because of concerns that the medication may trigger severe asthma attacks. Bisoprolol is reported to be more cardioselective than metoprolol and atenolol.4, Vasodilating beta-blockers, e.g. The Task Force for the Management of Patients with Ventricular GrepMed and the images sourced through this website are NOT a substitute for clinical judgement. Accessibility Australian Government. Increase dose at intervals of 2 weeks. Non-selective beta-blockers, e.g. Metoprolol succinate accounts for almost three-quarters of the beta-blockers dispensed in New Zealand. bisoprolol and metoprolol both increase anti-hypertensive channel blocking. Patients with heart failure with preserved ejection fraction (HF-PEF) may also be prescribed a beta-blocker if they Metoprolol succinate is an oral modified-release formulation taken once daily while most formulations of metoprolol tartrate Kirchhof P, Benussi S, Kotecha D, et al. Originally widely prescribed for hypertension and contraindicated Bisoprolol 5 mg PO DAILY. 2017. Metoprolol, sold under the brand name Lopressor, among others, is a selective 1 receptor blocker medication. Information on the management of acute coronary syndromes is available from: If Occasionally it may Last Modified: May 11, 2016. Try searching the Price Guide directly. Bisoprolol. should also be withdrawn slowly, ideally over several months, to prevent rebound symptoms such as resting Max: 25 mg twice a day. Elderly: Age does not significantly alter the pharmacokinetics of sotalol, but impaired renal function in elderly patients can increase the terminal half-life, resulting in increased drug accumulation. Elderly: Oral: Initial: 25 mg/day; usual range: 25-300 mg/day. Pulse rate was measured by palpation on radial artery for 1 minute. the dose to every second day for another month, before stopping treatment completely at the time when the patients next Beta blockers also help open up your veins and arteries to improve blood flow. The first dynamic daytime blood pressure monitoring was used as baseline. Low-fat dairy products. Information on the management of atrial fibrillation is available from: bpac.org.nz/2017/af.aspx. Extended release: 25-50 mg/day initially as a single dose; increase at 1- to 2-week intervals. with better outcomes.13 Beta-blockers may be more effective in younger patients with hypertension than older metoprolol 50mg BID. prescription would be due. There are three main sub-types of beta-adrenoceptors:3. Finally mean heart rate was recorded. A randomized controlled trial on the blood pressure-lowering effect of amlodipine and nifedipine-GITS in sustained hypertension. See also: bisoprolol side effects in more detail. Only monitoring data with valid data >=80% was used for analysis. Some beta-blockers, e.g. Two measurements were made at least 1 to 2 minutes apart. All beta-blockers are considered to be equally effective (as fourth-line treatment) Post-myocardial infarction. For this non-overlapping or abrupt switching, the current blocker should be discontinued approximately 12 hours before the first dose of carvedilol. Refer to the New Zealand Formulary for individual beta-blocker dosing regimens: www.nzf.org.nz. Bisoprolol (Zebeta) Esmolol (Brevibloc injection) Metoprolol tartrate (Lopressor) Metoprolol succinate (Toprol XL) Nebivolol . Micromedex Comparison Tables: Beta Blockers. government site. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Beta blockers may not work as effectively for black people and older people, especially when taken without other blood pressure medications. A review of the different properties of beta-blockers, their role tartrate 25 mg. Pharmaceutical Sciences. in practice they are now being stopped earlier in patients who are otherwise well, with no signs of angina or heart failure. All rights reserved. Water-soluble beta-blockers, e.g. Expression of beta-adrenergic receptor up-regulation is mediated by two different enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), diuretics or calcium channel blockers are associated Bisoprolol 5mg daily. The site is secure. This allows the heart to fill up with more blood between each beat and pump more efficiently. The first dynamic blood pressure monitoring was used as baseline. © Copyright BPAC NZ Limited (bpacnz) 2023. -, Eur Heart J. exclusively for rhythm control in patients with supraventricular and ventricular arrhythmias, but use By mouth using immediate-release medicines. You have reached the maximum number of saved studies (100). Zealand before alternative options, e.g. Beta-blockers should be started at a low dose and slowly titrated to maximum tolerated dose when used to treat patients Lopressor (metoprolol tartrate) lowers high blood pressure, controls chest pain, and helps treat heart failure and heart attack. Beta-blockers are initiated alongside an ACE inhibitor in all patients with heart failure with reduced ejection fraction Save my name, email, and website in this browser for the next time I comment. CSA Schedule ** View glossary of terms If you notice mild side effects, don't stop taking the beta-blocker without talking to your doctor first . Atenolol 50 mg PO DAILY. The first dynamic blood pressure monitoring was used as baseline. All Rights Reserved. Toprol XL comes in the following dosages: 25 mg. 50 mg. 100 mg. 200 mg. As mentioned, there is no direct conversion between atenolol and metoprolol succinate. Sotalol should be initiated and doses increased in a hospital with facilities for cardiac rhythm monitoring and assessment. Adult. Resident Editor: Patrick Azcarate, MD Keywords provided by Merck KGaA, Darmstadt, Germany: Why Should I Register and Submit Results? carvediolol or metoprolol, are metabolised Carruthers G, Shearer R, Taylor W, Moore M. J Clin Pharmacol. from: Morales DR, Jackson C, Lipworth BJ, et al. This can be increased to a maximum of 360 mg/day in divided doses. diltiazem. Proarrhythmic events can occur after initiation of therapy and with each upward dosage adjustment. All beta-blockers are considered to be equally effective although bisprolol or metoprolol may be preferred. Clinical outcomes with -blockers for myocardial infarction: a meta-analysis 4 hours. Bisoprolol was developed to be more cardio-specific than atenolol. Lowers blood pressure and controls heart rate. - Select active agent 2 - Metoprolol Atenolol Bisoprolol Nebivolol Propranolol Sotalol. Carvedilol, sustained release metoprolol, and bisoprolol all have relatively long half-lives . Lexi-Comp, Inc.; April 10, 2018. Atenolol and bisoprolol are both beta-blockers and are used to help treat high blood pressure, angina and heart failure. The difference between the mean ambulatory DBP observed in the last 4 hours after 12-week treatment and baseline was calculated to find out the change of mean ambulatory DBP at the end of the treatment. Patients were switched if they were stable on a minimum dose of 25 mg b.i.d. Blood pressure response was defined as DBP less than or equal to (=<) 90 mmHg or >=10 mmHg decrease in DBP from baseline. Tenormin (atenolol) is good for controlling chest pain and treating a heart attack. For general information, Learn About Clinical Studies. Moderate EH patients who have used anti-hypertension drugs, Subjects with history of coronary heart disease, Cerebrovascular events within 6 months before screening, Impaired hepatic or renal function (according to local lab standard), Other protocol defined exclusion criteria could apply. A total of 454 drugs are known to interact with bisoprolol: A total of 496 drugs are known to interact with metoprolol: ** The Controlled Substances Act (CSA) schedule information displayed applies to substances regulated under federal law. and New Zealand. Adverse respiratory effect of acute -blocker exposure in asthma: a systematic Beta blockers. There are many beta-blockers available, but some of the more common ones include: Starting: 3.125 mg twice a day for 2 weeks. PloS One 2014;9:e113048. The difference between the mean ambulatory SBP observed in the last 4 hours after 12-week treatment and baseline was calculated to find out the change of mean ambulatory SBP at the end of the treatment. Effect of d-sotalol on mortality in patients with left ventricular dysfunction In addition, the appropriate dosage . Bystolic (Nebivolol) is a good blood pressure-lowering medicine for people with heart conditions, and has fewer side effects than other beta blockers, but it's expensive. Johns Hopkins Guides. is no evidence that one beta-blocker is superior to another or that beta-blockers are superior to calcium channel blockers.8 The Prescriber 2010;5. Bangalore S, Makani H, Radford M, et al. official website and that any information you provide is encrypted atenolol 50mg daily. Adult. 1990 Feb;30(S2):S61-5. and then up-titrated at 12 week intervals (Table I). Beta-blockers are classified according to their adrenoceptor binding affinities (Table 1), the degree Carvedilol may lower blood pressure more than metoprolol. and may cause more bradycardia. Esmolol. and risks of treatment with beta-blockers. The most current price estimates are available at GoodRx.com. The recent disruption of the supply of metoprolol succinate where dispensing was limited to fortnightly or monthly amounts . Toprol XL is the brand name version of the long-acting, once-daily version of metoprolol but since there are generic versions of this drug (Metoprolol Succinate) I use those rather than Toprol XL. Bisoprolol or metoprolol; consider withdrawal after 612 months if re-vascularised and no other indications. Metoprolol has an average rating of Carvedilol 12.5 mg PO BID [immediate release] Carvedilol 40 mg PO DAILY [extended release] Labetalol 100 mg PO BID. and adverse effects.22, There is evidence that beta-blockers are under-prescribed to patients with COPD, yet they provide significant benefit Study record managers: refer to the Data Element Definitions if submitting registration or results information. Newer beta blockers, such as carvedilol (Coreg), dont usually cause weight gain as a side effect. Required fields are marked *. The maximum dose is 20 mg daily (single dose taken in the morning). 608 ratings on Drugs.com. Bookshelf Atenolol is available in 25 mg, 50 mg, and 100 mg tablets. Pulse rate was measured by palpation on radial artery for 1 minute. - Select active agent 1 - Metoprolol Atenolol Bisoprolol Nebivolol Propranolol Sotalol. However, the beta-blocking effects of these drugs have never been compared directly. Underuse of -blockers in heart failure and chronic obstructive pulmonary MeSH 40% of reviewers reported a positive effect, while 34% reported a negative effect. Metoprolol succinate, atenolol, bisoprolol, and nadolol have the advantages of longer half-lives and a single daily dosing, as well as affordability. This indicates that on average, the doctors switched carvedilol to a higher-than-recommended dose of bisoprolol. Wiysonge CS, Bradley HA, Volmink J, et al. meta-analysis of observational studies. Nebivolol is a racemate composed of d-Nebivolol and l-Nebivolol with the stereochemical designations of [SRRR]-nebivolol and [RSSS]-nebivolol, respectively. The dosages of bisoprolol were 2.5, 5 and 10 mg per day. Heart failure. CrCl <40, cirrhosis, heart failure (10mg . dosed once-daily and it is cardioselective (see below). Available from: OGara PT, Kushner FG, Ascheim DD, et al. Drug: Metoprolol Metoprolol 50 mg, Metoprolol 100 . for their myocardial infarction. of randomized trials. Cardiovasc Drugs Ther. Metoprolol 50 mg PO BID [immediate release] of bronchodilators.22, If a beta-blocker must be used in a patient with asthma, cardioselective beta-blockers, e.g. In Silico comparison between metoprolol succinate and bisoprolol on 24-hour systolic blood pressures. Pharmaceutical Claims Collection. are first-choice beta-blockers for patients with atrial fibrillation as they are prescribed once-daily and do not require Among these patients, the risk of mortality was not significantly different between carvedilol and metoprolol users (aHR, 0.97 [95% CI, 0.72-1.30]) . 5.7 out of 10 from a total of of further cardiac disease. What is the most effective beta blocker? Metoprolol is a selective beta-blocker at dosages usually prescribed to lower blood pressure or relieve the symptoms of angina. 77% of reviewers reported a positive effect, while 12% reported a negative . more. 2.5 mg. 2.5-10mg. For metoprolol doses 100 mg (i.e., medium to high doses) and systolic blood pressure >100 mm Hg, carvedilol was started at 12.5 mg b.i.d. sharing sensitive information, make sure youre on a federal Each ABPM lasted for at least 24 hours. View more, Metoprolol is a selective beta-blocker at dosages usually prescribed to lower blood pressure or relieve the symptoms of angina. tachycardia. Unable to load your collection due to an error, Unable to load your delegates due to an error. Both medications significantly reduce the risk of another heart attack from occurring, and there are no obvious differences between the 2 on this front. Malaise, vivid dreams, nightmares and in rare cases hallucinations may be caused by lipid-soluble beta-blockers crossing Available for Android and iOS devices. acebutolol 100mg BID. To view a report comparing 3 (or more) medications, please sign in or create an account. Pulse rate was measured by palpation on radial artery for 1 minute. Cardiovasc Ther 2013;31:7683. The half-life of atenolol is about six to seven hours, and therefore may last longer than some metoprolol doses. Its structural formula is: Metoprolol succinate is a white crystalline powder with a molecular weight of 652.8. Kapspargo Sprinkle, Lopressor, Metoprolol Succinate ER, Metoprolol Tartrate, Toprol-XL: Half Life The half-life of a drug is the time taken for the plasma concentration of a drug to reduce to half its original value. Nighttime in this study was defined as 10:00 pm to 06:00 am. atenolol, celiprolol or nadolol. Bisoprolol further significantly lowered the 24-h mean ambulatory, mean daytime and mean nighttime HR. 2 thanks. The dose of bisoprolol will be escalated to 7.5 mg orally once daily for next 4 weeks (Weeks 4 to 8) and to 10 mg orally once daily for the next 4 weeks (Weeks 8 to 12), if clinic systolic blood pressure (SBP) was greater than or equal to (>=) 140 millimeters of mercury (mmHg) and/or diastolic blood pressure (DBP) was >=90 mmHg measured every 4 weeks. In addition to blocking 1 receptors, non-selective beta blockers also block beta-2 (2) receptors in the body. Nebivolol Vs. Metoprolol: Comparative Effects on Fatigue and Quality of Life: Study Start Date : October 2009: Actual . The first nighttime blood pressure monitoring was used as baseline. The first dynamic blood pressure monitoring was used as baseline.
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