Summary
Metoprolol has reached the approved stage (maximum clinical phase 4) for at least one indication, so its use in Heart Failure would be drug repurposing rather than first-in-human development. This does not mean it is approved for Heart Failure. ClinicalTrials.gov lists 8 registered trials linking Metoprolol to Heart Failure: 2 are currently recruiting; 5 have completed; 1 is terminated, withdrawn, suspended or of unknown status. The most advanced is Phase 4 (NCT07298993). The largest enrolment is 685 participants (NCT04962711). Registration activity spans 2002 to 2026. The literature layer holds 17 publications for this pair: 5 Cochrane reviews, 4 meta-analyses, 3 systematic reviews and 5 clinical trial publications. Publication years run from 2015 to 2026. Because at least one synthesis-level source exists (systematic review, meta-analysis or Cochrane review), this pair has been assessed beyond single studies, although the synthesis may concern a different indication.
The RepurpOS disease-intelligence file for Heart Failure ranks 616 candidate therapeutics from Open Targets, ChEMBL, DGIdb and PubMed; only a minority carry direct clinical evidence, and this page covers one of those. Spontaneous remission context recorded for the condition: Annual mortality ~22% on standard care; only 5-11% of HFrEF patients achieve normalisation of ejection fraction (HFrecEF) with GDMT; HFpEF has no disease-modifying therapy.
Evidence table
| Evidence tier | A · Strong |
|---|---|
| Evidence score | 80.0 (trials 30.0, literature 30.0, tier 15, approved bonus 5.0) |
| Registered trials | 8 total: 2 recruiting, 0 active / not yet recruiting, 5 completed, 1 other |
| Linked publications | 17 (5 Cochrane reviews, 5 clinical trial publications, 4 meta-analyses, 3 systematic reviews) |
| Agent type | Drug (Small molecule) |
| Development stage (any indication) | Approved |
| Mechanism / class | Not recorded |
| Data sources | Open Targets, ChEMBL |
| Linked via biomarker / target | ABO |
How the evidence score is calculated
- Each registered trial scores by status (recruiting / active / enrolling 3, completed 2.5, not yet recruiting 2, unknown 1, terminated / withdrawn / suspended 0.5) plus a phase bonus (phase 3-4 +2, phase 2 +1, phase 1 +0.5). The trial component is capped at 30.
- Each literature item scores by design (Cochrane review 5, meta-analysis 4, systematic review 3, RCT 3, clinical trial publication 2, curated reference 1.5, other PubMed record 1). The literature component is capped at 30.
- The existing evidence tier adds 15 (A / Strong), 10 (B / Moderate), 5 (C / Preliminary) or 0 (D / Anecdotal).
- Agents approved for any indication (max clinical phase 4) add 5, because an approved agent has an established safety profile that lowers the barrier to repurposing trials.
- The score ranks what has been studied, not what works. It does not read effect sizes or directions of effect.
Registered clinical trials
| NCT ID | Title | Status | Phase | Enrolment |
|---|---|---|---|---|
| NCT04757584 | Pilot Deprescribing N-of-1 Trials for Beta-blockers in HFpEF 2021 | completed | Phase 4 | 9 |
| NCT00497003 | Effect of Beta Blocker Treatment on Endothelial Function in Patients With Type 2 Diabetes or Chronic Heart Failure 2004 | completed | Phase 4 | 50 |
| NCT00802230 | Pharmacodynamic Study of Carvedilol Versus Metoprolol in Heart Failure 2002 | completed | Phase 4 | 25 |
| NCT07298993 | Deprescribing Beta-Blockers in Elders With Heart Failure With Preserved Ejection Fraction (DEPRESCRIBE-HFpEF) 2026 | enrolling by invitation | Phase 4 | 240 |
| NCT00433043 | BOAT: Beta Blocker Uptitration With OptiVol After Cardiac Resynchronization Therapy (CRT) 2007 | terminated | Phase 4 | 2 |
| NCT01970501 | Genetically Targeted Therapy for the Prevention of Symptomatic Atrial Fibrillation in Patients With Heart Failure 2014 | completed | Phase 2 | 267 |
| NCT01434134 | Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy 2011 | completed | Phase 2 | 130 |
| NCT04962711 | Risk-guided Disease Management Plan to Prevent Heart Failure in Patients Treated With Previous Chemotherapy (REDEEM) 2023 | recruiting | Not applicable | 685 |
Published literature
- Clinical trial publication Calcium Channel Blockade Versus β-Blockade for Hypertension in Heart Failure With Preserved Ejection Fraction: A Randomized Crossover TrialCohen JB, Hossain A, Chittams J et al. · Hypertension (Dallas, Tex. : 1979) · 2026 · PMID 42137945
- Clinical trial publication Contemporary Oral Medication Use and Frequency in Patients with Transthyretin Amyloid CardiomyopathyDasgupta N, Poulsen SH, Emdin M et al. · American journal of cardiovascular drugs : drugs, devices, and other interventions · 2025 · PMID 40750720
- Clinical trial publication Effects of diltiazem and metoprolol on levels of high-sensitivity troponin I in patients with permanent atrial fibrillation: a randomized trialEnge K, Ulimoen SR, Enger S et al. · BMC cardiovascular disorders · 2025 · PMID 40087560
- Clinical trial publication [Calcium Dibutyryl Adenosine Cyclophosphate Enhances the Effect of Metoprolol in Treating Older Adults With Heart Failure Combined With Arrhythmia]Zheng H, Hu X · Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition · 2024 · PMID 38948272
- Clinical trial publication Beta-Blockers after Myocardial Infarction and Preserved Ejection FractionYndigegn T, Lindahl B, Mars K et al. · The New England journal of medicine · 2024 · PMID 38587241
- Meta-analysis Beta-blocker therapy in heart failure with preserved ejection fraction (B-HFpEF): A systematic review and meta-analysisKaddoura R, Madurasinghe V, Chapra A et al. · Current problems in cardiology · 2024 · PMID 38184132
- Systematic review Clinical Pharmacogenetics Implementation Consortium Guideline (CPIC) for CYP2D6, ADRB1, ADRB2, ADRA2C, GRK4, and GRK5 Genotypes and Beta-Blocker TherapyDuarte JD, Thomas CD, Lee CR et al. · Clinical pharmacology and therapeutics · 2024 · PMID 38951961
- Systematic review Influence of Weight and Body Size on the Pharmacokinetics of Heart Failure Pharmacotherapy: A Systematic ReviewHindi J, Fréchette-Le Bel M, Rouleau JL et al. · The Annals of pharmacotherapy · 2024 · PMID 37338205
- Meta-analysis Management of atrial flutter and atrial fibrillation with rapid ventricular response in patients with acute decompensated heart failure: A systematic reviewNiforatos JD, Ehmann MR, Balhara KS et al. · Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2023 · PMID 36326565
- Meta-analysis Beta-Blockers for Primary Prevention of Anthracycline-Induced Cardiac Toxicity: An Updated Meta-Analysis of Randomized Clinical TrialsAttar A, Behnagh AK, Hosseini M et al. · Cardiovascular therapeutics · 2022 · PMID 36687509
- Meta-analysis Model-based meta-analysis of changes in circulatory system physiology in patients with chronic heart failureTakaoka R, Soejima Y, Guro S et al. · CPT: pharmacometrics & systems pharmacology · 2021 · PMID 34218511
- Systematic review Extracorporeal treatment for poisoning to beta-adrenergic antagonists: systematic review and recommendations from the EXTRIP workgroupBouchard J, Shepherd G, Hoffman RS et al. · Critical care (London, England) · 2021 · PMID 34112223
- Cochrane review Role of cardioprotective agents on chemotherapy-induced heart failure: A systematic review and network meta-analysis of randomized controlled trialsLi X, Li Y, Zhang T et al. · Pharmacological research · 2020 · PMID 31790821
- Cochrane review Meta-Analysis Comparing Metoprolol and Carvedilol on Mortality Benefits in Patients With Acute Myocardial InfarctionLi J, Chen Z, Gao X et al. · The American journal of cardiology · 2017 · PMID 28882337
- Cochrane review Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Chronic Heart FailureRossano JW, Cabrera AG, Jefferies JL et al. · Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2016 · PMID 26945326
- Cochrane review Beta-adrenergic blockers for perioperative cardiac risk reduction in people undergoing vascular surgeryMostafaie K, Bedenis R, Harrington D · The Cochrane database of systematic reviews · 2015 · PMID 25879091
- Cochrane review Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillationLafuente-Lafuente C, Valembois L, Bergmann JF et al. · The Cochrane database of systematic reviews · 2015 · PMID 25820938
Mechanism and notes
No mechanism of action is recorded for this pair in the source databases.
OSMF's existing evidence tier for this pair is A (Strong), derived from the strength of the disease association recorded in Open Targets and ChEMBL, in this case via the biomarker or target ABO. The tier describes how well the drug-disease link is documented, not how well the drug works.
Frequently asked questions
Is Metoprolol approved for Heart Failure?
Metoprolol has reached the approved stage (maximum clinical phase 4) for at least one indication, so its use in Heart Failure would be drug repurposing rather than first-in-human development. This does not mean it is approved for Heart Failure. Approval status for the specific indication should always be confirmed with the relevant regulator and prescribing information.
Is Metoprolol in clinical trials for Heart Failure?
ClinicalTrials.gov lists 8 registered trials linking Metoprolol to Heart Failure: 2 are currently recruiting; 5 have completed; 1 is terminated, withdrawn, suspended or of unknown status. The most advanced is Phase 4 (NCT07298993). The largest enrolment is 685 participants (NCT04962711). Registration activity spans 2002 to 2026.
What does the evidence show for Metoprolol in Heart Failure?
Metoprolol has both completed registered trials and synthesis-level publications linked to Heart Failure. That is the strongest profile in this database, but the summaries here do not extract effect sizes, so read the linked reviews for direction and magnitude of benefit. OSMF's existing evidence tier for this pair is A (Strong), derived from the strength of the disease association recorded in Open Targets and ChEMBL, in this case via the biomarker or target ABO. The tier describes how well the drug-disease link is documented, not how well the drug works.
Cite this page
Data: ClinicalTrials.gov, PubMed, Open Targets, ChEMBL, DGIdb and the OSMF therapeutic agent database. Last updated 2026-07-05. Page built 2026-10-07.