RecentRCT

Metoprolol without cardiovascular disease

Metoprolol in Chronic Obstructive Pulmonary Disease without Cardiovascular Disease.

NEJM evidence, 2026 · Open-label pragmatic randomized phase 4 trial

Population: 1,695 adults with COPD, sinus rhythm and no cardiovascular disease
Intervention: Metoprolol targeting 100 mg daily plus usual care
Comparator: Usual care
Primary outcome: First COPD exacerbation, cardiovascular event or death within one year
Result: 27% versus 30%; HR 0.87 (95% CI 0.73–1.05), P=.14. Serious adverse events: 9.4% versus 7.8%.

What the trial found

27% versus 30%; HR 0.87 (95% CI 0.73–1.05), P=.14. Serious adverse events: 9.4% versus 7.8%.

Clinical interpretation

Do not initiate metoprolol solely to prevent COPD exacerbations on these results. This does not justify withholding a cardioselective beta-blocker for an established cardiac indication.

Limitations

Open-label; primary composite not significantly improved; estimates for individual outcomes were imprecise.
The enrolled population explicitly excluded cardiovascular disease.

Moderate certainty

Clinical Context & Relevant Topics (1)

Disease Reference

COPD Exacerbation (Acute & Severe)

Pathophysiology of acute-on-chronic hypercapnia, controlled oxygen targets (88–92%), evidence-based NIV, and auto-PEEP matching mechanics.

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