Metoprolol in Chronic Obstructive Pulmonary Disease without Cardiovascular Disease
- Journal
- NEJM evidence (Q1)
- Published
- 6 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Josefin Sundh, Anders Magnuson, Marika Kvarnström, Folke Sjöberg, Magnus Ekström, Johan SanMartin Berglund, et al.
- PMID
- 42701865
- DOI
- 10.1056/EVIDoa2600231
Why clinicians should know about it
- Picked for Pulmonary and Respiratory Medicine (top studies of the week, 13 September 2026): Phase 4 RCT of metoprolol in COPD without CVD
- Picked for Family Practice (paper of the day, 8 September 2026): Metoprolol trial in COPD without CVD
Abstract
BACKGROUND: Beta-blockers may improve outcomes in patients with chronic obstructive pulmonary disease (COPD) without cardiovascular disease, but randomized trials have been inconclusive. METHODS: This was a multicenter, open-label, pragmatic, phase 4 randomized trial. Patients 40 years of age or older with COPD, sinus rhythm, and no cardiovascular disease were randomly assigned in a 1:1 ratio to receive metoprolol, at a target dose of 100 mg daily, in addition to standard care or to receive standard care alone. The primary end point was the time to the first occurrence of a COPD exacerbation, cardiovascular event, or death during 1 year of follow-up. RESULTS: A total of 1695 patients underwent random assignment; their mean age was 70 years, and 62% were female. The primary end point occurred in 27% of patients assigned to receive metoprolol and in 30% assigned to receive standard care (hazard ratio, 0.87; 95% confidence interval [CI], 0.73 to 1.05; P=0.14). The corresponding hazard ratios were 0.88 (95% CI, 0.72 to 1.06) for COPD exacerbations, 0.73 (95% CI, 0.48 to 1.11) for cardiovascular events, 0.92 (95% CI, 0.48 to 1.77) for death, and 0.87 (95% CI, 0.58 to 1.28) for exacerbations requiring hospitalization. Serious adverse events occurred in 80 (9.4%) of 848 participants in the metoprolol group and 66 (7.8%) of 847 participants in the standard care group. Nonserious adverse events occurred in 293 (34.6%) of 848 patients in the metoprolol group and 247 (29.2%) of 847 in the standard care group. CONCLUSIONS: Among patients with COPD and no cardiovascular disease, metoprolol did not significantly improve the time to a composite of exacerbations, cardiovascular events, or death. (Funded by research grants from the Swedish Research Council and others; ClinicalTrials.gov number, NCT03566667.).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.