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Background: Beta-blockers are widely used, with continuously updated clinical recommendations. However, their application faces challenges in personalized treatment and safety. The study aimed to investigate the frequency and patterns of prescribing beta-blockers in China and to explore potential adverse event risk signals associated with beta-blockers, providing reference for rational medication use in clinical settings. Methods: Prescription data for beta-blockers from January 2018 to June 2023 were extracted through the Hospital Prescription Analysis Collaborative Project in China to analyze clinical usage trends. While adverse drug reaction reports for beta-blockers were obtained from the FDA Adverse Event Reporting System (FAERS) database. The classification and standardization of adverse drug event (ADE) reports were based on the preferred terms (PT) and corresponding system organ classes (SOC) from the Medical Dictionary for Regulatory Activities (MedDRA). Signal detection utilized a proportion imbalance method. Results: In clinical practice, metoprolol dominated beta-blocker prescriptions in China, accounting for 62.2%. Beta-blockers were primarily prescribed to the elderly (65.7%) and male patients (57.0%). However, off-label use of beta-blockers was relatively widespread. For instance, sotalol was prescribed for hypertension at 18.25%, while esmolol was used for angina and heart failure at rates of 12.94% and 14.98%, respectively. In addition, we identified newly discovered adverse reactions associated with beta-blockers, such as BRASH syndrome (metoprolol: n = 186, ROR = 391.285; carvedilol: n = 72, ROR = 256.459), acute kidney injury (bisoprolol: n = 247, ROR = 5.641), premature baby (labetalol: n = 110, ROR = 91.385), and sleep disorder (propranolol: n = 254, ROR = 10.98). Conclusions: Metoprolol led the beta-blocker market in China. Attention was warranted regarding the newly discovered adverse reactions, such as the risk of acute kidney injury with bisoprolol and the potential for BRASH syndrome with metoprolol and carvedilol. [ABSTRACT FROM AUTHOR]

In the present study, a modified carbon nano-onion and β–cyclodextrin composite was utilized in micro-solid phase extraction of atenolol and metoprolol from human plasma samples. The synthesized sorbent structure and morphology were evaluated. In this method, a proper amount of the sorbent was contacted with the diluted plasma sample under vortexing (to promote the sorbent contact area with the solution). The separated particles by centrifugation were contacted with a proper eluent to desorb the target analytes. After that, the eluent was separated by centrifugation and used during analysis of the analytes by high-performance liquid chromatograph. Several effective extraction parameters such as the sorbent amount, type and elution solvent volume, and extraction time were evaluated and optimized. The validated factors showed that detection and quantification were 0.09 and 0.01 and 0.29 and 0.03 ng mL–1, for metoprolol and atenolol, respectively. The method precision, considered as relative standard deviation, was ≤ 2.5 and ≤ 3.6% for intra- (n = 5) and inter-day (n = 4) precisions, respectively. The extraction recovery values were obtained 84 and 63% for metoprolol and atenolol, respectively. Lastly, the developed method was utilized successfully on the plasma samples of patients treated with metoprolol and atenolol. [ABSTRACT FROM AUTHOR]

This study aims to clarify the process of oral drug absorption from jelly formulations. Agar and pectin-based jellies containing drugs with different membrane permeability (high: antipyrine [ANT], medium: metoprolol [MET], low: atenolol [ATE]) were prepared and tested for in vitro drug release and in vivo drug absorption in rats. All drugs showed similar release profiles in vitro from both jelly formulations, except for the faster release from pectin jelly at neutral pH. In contrast, in vivo absorption of ATE but not of ANT from jelly formulations was significantly lower than from solution. Absorption of ATE and MET was low from agar jelly after oral administration, whereas additional water intake significantly increased the absorption. The process of drug absorption was described by the compartmental model consisting of jelly, intestinal fluid, and blood compartments. Drugs in the jelly diffuse into the intestinal fluid and then permeate the intestinal membrane. By considering the rate-limiting process, membrane permeability-dependent drug absorption from agar jelly and the effects of water intake were identified. In conclusion, jelly formulations may potentially decrease and delay drug oral absorption, especially of poorly permeable drugs. Intestinal fluid volume is one of the important factors to control the drug absorption. [Display omitted] • Although oral jelly formulations are often used for pediatric or elderly patients because of their high swallowability, the precise process and mechanism of gastrointestinal (GI) drug absorption from oral jelly formulations are not fully understood. This study examined the process of drug absorption from oral jelly formulations. • In this study, the compartmental model was used to describe the unique process of drug absorption from oral jelly formulations, in which drugs dissolved in the jelly reach the intestinal fluid via diffusion through the jelly matrix. By defining the rate-limiting process of drug absorption from oral jelly formulations, the effects of the membrane permeability of the drug and GI fluid volume were identified. • The correlation between in vitro drug release and in vivo oral absorption from oral jelly formulations observed in this study will help to consider the bioequivalence of oral jelly formulations with other formulations (e.g., solution, tablet). • To clearly demonstrate the effect of membrane permeability, three model drugs with different permeabilities were incorporated in the jelly and administered to rats as a cassette. • Two different methods, intra-intestinal and oral administration, were used for in vivo drug administration to rats. The results of the intra-intestinal administration study revealed the basic mechanism of drug absorption from oral jelly formulations, whereas the oral administration study highlighted the clinical importance of water intake for drug absorption. [ABSTRACT FROM AUTHOR]

Background: Metoprolol is commonly administered to critically ill patients; however, its effect on mortality in patients with sepsis-induced cardiomyopathy (SICM) remains uncertain. This study aimed to investigate the relationship between metoprolol use and mortality in patients with SICM. Methods: Adults with SICM were identified from the MIMIC-IV database. The exposure of interest was metoprolol treatment. The outcomes assessed were 30-day mortality, 1-year mortality, and in-hospital mortality. Kaplan–Meier survival analysis evaluated the effect of metoprolol on these outcomes. Multivariable Cox proportional hazards and logistic regression analyses were performed to determine the correlation between metoprolol treatment and mortality in patients with SICM. Results: 1163 patients with SICM were identified, with 882 receiving metoprolol treatment (MET group) and 281 not receiving metoprolol treatment (NOMET group). Overall, the 30-day, 1-year, and in-hospital mortality rates were 10.2%, 18.2%, and 8.9%, respectively. Significant differences in mortality existed between the groups. Multivariable Cox analysis revealed that patients in the NOMET group had a higher risk of 1-year mortality (adjusted hazard ratio [HR] 2.493; 95% confidence interval [CI] 1.800–3.451; P < 0.001) and 30-day mortality (adjusted HR 4.280; 95%CI 2.760–6.637; P < 0.001). Metoprolol treatment was associated with lower in-hospital mortality (odds ratio [OR] 5.076; 95% CI 2.848–9.047; P < 0.001). Subgroup analysis supported these findings. Conclusion: Metoprolol treatment is associated with reduced all-cause mortality in patients with SICM. Prospective studies are required to validate these findings. [ABSTRACT FROM AUTHOR]

Background: Although beta blockers, such as metoprolol, have been widely used in the management of vasovagal syncope (VVS), their efficacy remains debated, with larger studies showing limited benefit. Identifying patient-specific characteristics that predict a positive response to metoprolol could optimize its use. This study aims to investigate the key factors that may determine which VVS patients are suitable candidates for metoprolol treatment. Methods: This retrospective study was conducted at a single center. Patients diagnosed with VVS and treated with metoprolol for a minimum of three months were included. A 50% reduction in syncope symptom score (SS) after three months of metoprolol treatment was used to define metoprolol responders, while those who did not achieve this reduction were classified as non-responders. After a three-month follow-up, patients were divided into two groups: responders and non-responders. Baseline data—including age, gender, comorbidities, laboratory tests, and the type of VVS—were analyzed for each patient. Changes in heart rate (HR) and blood pressure during the head-up tilt test (HUTT) were also evaluated between the two groups. Logistic regression analysis was performed to identify potential predictors of metoprolol response, and receiver operating characteristic (ROC) curve analysis was used to assess the value of these predictors in selecting potential responders. Results: A total of 168 VVS patients were enrolled between January 2016 and December 2020. Of these, 100 patients responded positively to metoprolol, while 68 did not. No significant differences in baseline characteristics or HUTT results were observed between the two groups (p > 0.05). However, responders exhibited a significantly higher peak HR compared to non-responders during the HUTT (120.13 ± 19.33 vs. 106.60 ± 22.32, p < 0.001). The increase in HR was also more pronounced in responders (0.60 ± 0.23 vs. 0.41 ± 0.25, p < 0.001). Additionally, HR variability was significantly greater in responders than in non-responders (16.18 ± 5.51 vs. 12.61 ± 5.50, p < 0.001). Conclusion: Higher peak HR, larger increases in HR, and greater HR variability during the HUTT may serve as reliable predictors of a positive response to metoprolol in patients with VVS. [ABSTRACT FROM AUTHOR]

Pharmaceutical compounds, such as ibuprofen and metoprolol, are of increasing concern due to their persistence in the environment and potential adverse effects on human health. In this work, we developed an electrochemical sensor system for the determination of ibuprofen and metoprolol based on a modified manganese oxide nanoparticle (MnO2NPs) on a screen‐printed carbon electrode (SPCE). The characterisation of MnO2NPs modifier was investigated via Fourier transform infrared (FTIR), X‐ray diffraction (XRD), scanning electron microscopy (SEM), Raman spectroscopy techniques, Uv/vis spectroscopy, and small‐angle X‐ray scattering spectroscopy. The electrochemical behaviour of the MnO2NPs was studied using differential pulse voltammetry (DPV) and cyclic voltammetry (CV) techniques. The optimum experimental conditions were investigated by examining the effects of scan rates, pH on the CV responses, and electrolytes on the DPV response. The MnO2NPs modified electrode demonstrated enhanced catalytic activity in the electro‐oxidation of both ibuprofen and metoprolol. The oxidation peaks of ibuprofen and metoprolol were observed at +1.14 V and +1.46 V, respectively, for the MnO2NPs/SPCE sensor. The sensor's limit of detection was 3.81 pM and 4.6 pM respectively and its linear response was from 0.97–5.82 pM. Furthermore, interference and stability studies were conducted to evaluate the performance of the MnO2NPs/SPCE sensor under optimum conditions, which resulted in a good performance. The proposed sensor was successfully used for the determination of ibuprofen and metoprolol in the application of real water samples. [ABSTRACT FROM AUTHOR]

Background: Functional endoscopic sinus surgery (FESS) is one of the most performed surgical procedures and requires minimal bleeding during the procedure. The success of surgeries is largely dependent on the surgical field, where the presence of significant bleeding is an important factor. Aims and Objectives: The objectives of this study were to evaluate the clinical efficacy of oral clonidine and metoprolol following their pre-medication for induced hypotension during FESS and to assess hemodynamic stability, surgical field quality, and sedation score. Materials and Methods: This is an observational hospital-based study conducted on 60 patients, aged 18-60 years old for FESS assigned by randomization method in two groups including clonidine or metoprolol. Heart rate (HR) and arterial blood pressure are measured after induction, during and end of the surgery. Assessment of bleeding was done by a surgeon who was blinded. Surgical field quality, satisfaction level of the surgeon, Aldrete score, and any side effects were observed. Results: There was no significant difference seen in HR in patients of Group C and Group M in the pre-operative period, after loading the dose of the drug, at extubation (P>0.05). A significant difference was seen in HR with lower mean values in Group C compared to Group M after induction (77.23±12.23), 10 min after induction (69.47±11.99), 20 min after induction (65.63±8.66), 30 min after induction (64±8.32), 40 min after induction (63.77±7.61), and 60 min after induction (63.63±7.89). A significant difference was seen in blood pressure, after loading the dose of the drug, after induction, during surgery monitored every 10 min, at extubation, after extubation monitored every hour for 6 h. Quality of surgical field and surgeon's satisfaction was better in patients who received clonidine than in those who received metoprolol. Conclusion: Both clonidine and metoprolol can be effectively used for induced hypotension in FESS. Clonidine is better than metoprolol with respect to intraoperative hemodynamics, quality of the surgical field, and surgeon's satisfaction with the added advantage of sedation, reduced analgesia requirement, and other anesthetic drugs. [ABSTRACT FROM AUTHOR]

Atenolol is a commonly used beta bloscker in non-pregnant women. Many providers are hesitant in prescribing atenolol in pregnancy because of a possible association with poor fetal growth. We aimed to assess the association between atenolol and the occurrence of small for gestational age neonates compared to other beta blockers, as described in the existing literature. We used the meta-analytic method to generate a forest plot for risk ratios (RR) of small for gestational age in patients who used atenolol vs. other beta blockers. Statistical heterogeneity was assessed with the I2 statistic. Two studies were included, with a resultant RR of 1.94 [95 % confidence interval (CI) 1.60; 2.35]. A study by Duan et al. in 2018 noted the following rate of small for gestational age for each beta blocker use: 112/638 atenolol, 590/3,357 labetalol, 35/324 metoprolol, and 50/489 propranolol. A study by Tanaka et al. in 2016 noted the following rate of small for gestational age: 8/22 for propranolol, 2/12 for metoprolol, 2/6 for atenolol, 0/5 for bisoprolol. Heterogeneity (I2) was 0 %. Our results suggested an elevated risk of small for gestational age associated with atenolol use in comparison to other beta blockers, specifically labetalol, propranolol, bisoprolol, and metoprolol. [ABSTRACT FROM AUTHOR]

Background: Otosclerosis is one of the most frequent causes of conductive hearing loss in adults. Surgical treatment is considered to be the gold standard for this disease. Endoscopic stapedectomy is a new approach for the treatment of otosclerosis that requires a bloodless field. Aim of the Study: To determine whether the routine use of β blockers as a premedication can improve the operative field in endoscopic stapedectomy or not. Patients and Methods: Sixty patients aged from 18 to 50 years, undergoing endoscopic stapedectomy, were included in this prospective, randomized, double blinded, placebo-controlled study. Patients were randomly assigned to receive either metoprolol 100 mg (group 1) or a placebo, vitamin tablet, (group 2) 60 min before surgery. Results: The age, gender, body weight and ASA physical status were comparable between the two groups. The average blood loss in the placebo group was significantly greater than in the metoprolol group, but the time of operation in the metoprolol group was not significantly shorter. The surgical field was assessed using the Fromme-Boezaart scale, and those who received metoprolol had considerably cleaner (p0.001) surgical fields. The mean arterial pressure (MAP) didn't differ statistically significant at basal measurement up to 30 min after anesthesia induction while it was significantly lower in the metoprolol group after 30 min of induction up to end of surgery (p < 0.001). The heart rate was also significantly lower (p < 0.001) in patients who received metoprolol from prior to anesthesia induction up to end of surgery. Conclusion: metoprolol significantly improves visual clarity and hemodynamics during endoscopic stapedectomy. [ABSTRACT FROM AUTHOR]

This study investigates the effect of a novel drug-drug solid dispersion approach on the dissolution of hydrochlorothiazide in a fixed-dose combination with metoprolol tartrate. Solid dispersions of hydrochlorothiazide and metoprolol tartrate (12.5 mg: 25 mg) were prepared using the solvent evaporation technique. These dispersions were characterized by differential scanning calorimetry (DSC), Fourier-transform infrared spectroscopy (FTIR). The prepared solid dispersions, along with selected excipients, were compressed into orodispersible tablets and evaluated for precompression and post compression parameters. The solubility of hydrochlorothiazide was observed to increase with the concentration of metoprolol tartrate, as demonstrated by phase solubility studies and comparative solubility studies. Stability studies on the tablets indicated no significant changes in disintegration time, dissolution profile, or overall stability. The findings of this study suggest that the novel drug-drug solid dispersion approach is promising for enhancing the dissolution of poorly soluble drugs, when combined with soluble drugs in fixed-dose combinations. [ABSTRACT FROM AUTHOR]

Background: Patients who present to the emergency department (ED) with severe hypertension defined as a systolic blood pressure (SBP) ≥180 millimeters of mercury (mm Hg) or diastolic (DBP) ≥120 (mm Hg) without evidence of acute end-organ damage are often deemed high risk and treated acutely in the ED. However, there is a dearth of evidence from large studies with long-term follow-up for the assessment of major adverse cardiovascular events (MACE). We conducted the largest study to date of patients presenting with severe hypertension to identify predictors of MACE and examine whether blood pressure at discharge is associated with heightened risk. Methods: We enrolled ED patients with a SBP of 180–220 mm Hg but without signs of end-organ damage and followed them for one year. The primary outcome was MACE within one year of discharge. Secondarily, we performed a propensity-matched analysis to test whether SBP ≤160 mm Hg at discharge was associated with reduced MACE at 30 days. Results: A total of 12,044 patients were enrolled. The prevalence of MACE within one year was 1,865 (15.5%). Older age, male gender, history of cardiovascular disease, cerebrovascular disease, diabetes, smoking, presentation with chest pain, altered mental status, dyspnea, treatment with intravenous and oral hydralazine, and oral metoprolol were independent predictors for one-year MACE. Additionally, discharge with an SBP ≤160 mm Hg was not associated with 30-day MACE-free survival after propensity matching (hazard ratio 0.99, 95% confidence interval 0.78–1.25, P = 0.92). Conclusion: One-year MACE was relatively common in our cohort of ED patients with severe hypertension without acute end-organ damage. However, discharge blood pressure was not associated with 30-day or one-year MACE, suggesting that BP reduction in and of itself is not beneficial in such patients. [ABSTRACT FROM AUTHOR]

The biophysical properties of metoprolol are investigated by the full potential-linearized augmented plane wave method and molecular docking and molecular dynamic approaches. The exchange–correlation potentials are calculated by the Perdew–Burke–Ernzerhof generalized gradient approximation as implemented in the WIEN2k package. The electronic results show the insulator nature of metoprolol with the indirect bandgap of 3.74 eV between HOMO and LUMO states. In the density of state spectra, the p state of O, C, and N elements confirm the stability of metoprolol. Metoprolol exhibits a metallic behavior in the z direction, while it has a dielectric behavior in the x and y directions. The static refractive indices are obtained 1.49, 1.53, and 1.63 in the x, y, and z directions, respectively. It was found that the maximum reflectivity occurs at the ultraviolet region in the z-direction. The calculated absorption spectra also confirm the other's experimental results. The obtained results of molecular docking indicate the formation of hydrogen bonds between metoprolol and the beta-2 adrenergic receptors, and molecular dynamics showed a human beta-2 adrenoceptor either in its free state or in complex with a metoprolol molecule. The calculated binding energies of elements by molecular docking and the other biological properties of metoprolol by molecular dynamic are in close agreement with obtained Density Functional Theory (DFT) results for Pharmacia applications. [ABSTRACT FROM AUTHOR]

Background: Vasovagal syncope (VVS) is the most common type of orthostatic intolerance in children. We investigated whether platelet-related factors related to treatment efficacy in children suffering from VVS treated with metoprolol. Methods: Metoprolol-treated VVS patients were recruited. The median duration of therapy was three months. Patients were followed and divided into two groups, treament-effective group and treatment-ineffective group. Logistic and least absolute shrinkage selection operator regressions were used to examine treatment outcome variables. Receiver-operating characteristic (ROC) curves, precision–recall (PR) curves, calibration plots, and decision curve analyses were used to evaluate the nomogram model. Results: Among the 72 patients who complete the follow-up, treatment-effective group and treatment-ineffective group included 42 (58.3%) and 30 (41.7%) cases, respectively. The patients in the treatment-effective group exhibited higher mean platelet volume (MPV) [(11.0 ± 1.0) fl vs. (9.8 ± 1.0) fl, P < 0.01] and platelet distribution width [12.7% (12.3%, 14.3%) vs. 11.3% (10.2%, 12.2%), P < 0.01] than those in the treatment-ineffective group. The sex ratio was significantly different (P = 0.046). A fit model comprising age [odds ratio (OR) = 0.766, 95% confidence interval (CI) = 0.594–0.987] and MPV (OR = 5.613, 95% CI = 2.297–13.711) might predict therapeutic efficacy. The area under the curve of the ROC and PR curves was computed to be 0.85 and 0.9, respectively. The P value of the Hosmer–Lemeshow test was 0.27. The decision curve analysis confirmed that managing children with VVS based on the predictive model led to a net advantage ranging from 0.01 to 0.58. The nomogram is convenient for clinical applications. Conclusion: A novel nomogram based on age and MPV can predict the therapeutic benefits of metoprolol in children with VVS. [ABSTRACT FROM AUTHOR]

Metoprolol is a cardioselective beta-blocker drug often used to treat hypertension, but it is considered as a hazardous organic persistent contaminant in wastewater. In this study, a 2.5 L solution of metoprolol (50 mg/L) underwent electro-oxidation in a flow-by reactor using boron-doped diamond electrodes in the batch recirculation mode. The study used multi-objective optimization and multi-criterion decision-making to determine the optimal operating parameters. The response surface methodology and a central composite rotatable design were used with three factors (pH0: 5–8, I: 2.5–4 A, and Q: 0.8–1.7 L/min) to model the chemical oxygen demand's (COD's) removal efficiency and the total organic carbon's (TOC's) removal efficiency. The experimental responses were modeled by reduced third- and second-order polynomials with determination coefficients (R2) of 0.9816 and 0.9430. The optimal operating parameters were found to be pH0 5, an I value of 3.84 A, and a Q value of 0.8 L/min with an electrolysis time of 7.5 h, resulting in a maximum COD removal efficiency of 60.8% and a TOC removal efficiency of 90.1%. The specific energy consumption was calculated as 9.61 kWh/mg of TOC, with a total operating cost of 0.77 USD/L. In conclusion, this study showed that the electrochemical process is efficient and reliable for treating wastewater containing metoprolol. [ABSTRACT FROM AUTHOR]

Concerns related to environmental risks associated with pharmaceuticals and personal care products (PPCPs) have led researchers to seek methods for assessing and monitoring these contaminants in the aquatic environment. Identifying and validating risk assessment tools that can evaluate ecological concerns and risks associated with PPCPs is critical. Herein, the suitability of a dose-related risk and effect assessment model, which estimates predicted environmental concentrations and allowed comparisons with predicted no effect concentrations determined, in combination with in vitro analyses of the whole effluent toxicity, was verified for the characterization of a PPCP hazard. Concentrations of the most utilized PPCPs in Norway were measured in influent and effluent samples and used to parameterize the fate model. Greater than 90% removal was attained for 12 out of 22 detected PPCPs. Removal was not dependent on the class or the concentration of the specific substance and varied between 12% and 100%. The PPCPs detected in the discharged wastewater were utilized to assess individual contributions to the risk of the effluent, and no risk was identified for the targeted 30 PPCP. The simulations provided valuable information regarding the discharge plume distribution over time, which can aid planning of future environmental monitoring investigations. Bioassays (using fish liver cells, PLHC-1) were used for assessing overall effluent toxicity, through cell viability, production of reactive oxygen species, and ethoxyresorufin-O-deethylase (EROD) activities. The present study may allow regulators to use risk-based strategies over removal criteria for monitoring studies and confirms the importance to take PPCP contamination into consideration when establishing environmental regulations. [ABSTRACT FROM AUTHOR]

Abstract Background Metoprolol is commonly administered to critically ill patients; however, its effect on mortality in patients with sepsis-induced cardiomyopathy (SICM) remains uncertain. This study aimed to investigate the relationship between metoprolol use and mortality in patients with SICM. Methods Adults with SICM were identified from the MIMIC-IV database. The exposure of interest was metoprolol treatment. The outcomes assessed were 30-day mortality, 1-year mortality, and in-hospital mortality. Kaplan–Meier survival analysis evaluated the effect of metoprolol on these outcomes. Multivariable Cox proportional hazards and logistic regression analyses were performed to determine the correlation between metoprolol treatment and mortality in patients with SICM. Results 1163 patients with SICM were identified, with 882 receiving metoprolol treatment (MET group) and 281 not receiving metoprolol treatment (NOMET group). Overall, the 30-day, 1-year, and in-hospital mortality rates were 10.2%, 18.2%, and 8.9%, respectively. Significant differences in mortality existed between the groups. Multivariable Cox analysis revealed that patients in the NOMET group had a higher risk of 1-year mortality (adjusted hazard ratio [HR] 2.493; 95% confidence interval [CI] 1.800–3.451; P

Abstract Background Although beta blockers, such as metoprolol, have been widely used in the management of vasovagal syncope (VVS), their efficacy remains debated, with larger studies showing limited benefit. Identifying patient-specific characteristics that predict a positive response to metoprolol could optimize its use. This study aims to investigate the key factors that may determine which VVS patients are suitable candidates for metoprolol treatment. Methods This retrospective study was conducted at a single center. Patients diagnosed with VVS and treated with metoprolol for a minimum of three months were included. A 50% reduction in syncope symptom score (SS) after three months of metoprolol treatment was used to define metoprolol responders, while those who did not achieve this reduction were classified as non-responders. After a three-month follow-up, patients were divided into two groups: responders and non-responders. Baseline data—including age, gender, comorbidities, laboratory tests, and the type of VVS—were analyzed for each patient. Changes in heart rate (HR) and blood pressure during the head-up tilt test (HUTT) were also evaluated between the two groups. Logistic regression analysis was performed to identify potential predictors of metoprolol response, and receiver operating characteristic (ROC) curve analysis was used to assess the value of these predictors in selecting potential responders. Results A total of 168 VVS patients were enrolled between January 2016 and December 2020. Of these, 100 patients responded positively to metoprolol, while 68 did not. No significant differences in baseline characteristics or HUTT results were observed between the two groups (p > 0.05). However, responders exhibited a significantly higher peak HR compared to non-responders during the HUTT (120.13 ± 19.33 vs. 106.60 ± 22.32, p

Background: Functional endoscopic sinus surgery (FESS) is one of the most performed surgical procedures and requires minimal bleeding during the procedure. The success of surgeries is largely dependent on the surgical field, where the presence of significant bleeding is an important factor. Aims and Objectives: The objectives of this study were to evaluate the clinical efficacy of oral clonidine and metoprolol following their pre-medication for induced hypotension during FESS and to assess hemodynamic stability, surgical field quality, and sedation score. Materials and Methods: This is an observational hospital-based study conducted on 60 patients, aged 18–60 years old for FESS assigned by randomization method in two groups including clonidine or metoprolol. Heart rate (HR) and arterial blood pressure are measured after induction, during and end of the surgery. Assessment of bleeding was done by a surgeon who was blinded. Surgical field quality, satisfaction level of the surgeon, Aldrete score, and any side effects were observed. Results: There was no significant difference seen in HR in patients of Group C and Group M in the pre-operative period, after loading the dose of the drug, at extubation (P>0.05). A significant difference was seen in HR with lower mean values in Group C compared to Group M after induction (77.23±12.23), 10 min after induction (69.47±11.99), 20 min after induction (65.63±8.66), 30 min after induction (64±8.32), 40 min after induction (63.77±7.61), and 60 min after induction (63.63±7.89). A significant difference was seen in blood pressure, after loading the dose of the drug, after induction, during surgery monitored every 10 min, at extubation, after extubation monitored every hour for 6 h. Quality of surgical field and surgeon’s satisfaction was better in patients who received clonidine than in those who received metoprolol. Conclusion: Both clonidine and metoprolol can be effectively used for induced hypotension in FESS. Clonidine is better than metoprolol with respect to intraoperative hemodynamics, quality of the surgical field, and surgeon’s satisfaction with the added advantage of sedation, reduced analgesia requirement, and other anesthetic drugs.