Key result
Interrupting β-blockers after MI raises systolic blood pressure and increases major events ~5% in hypertensive patients.
Why the study?
This study aimed to evaluate the effects of beta-blocker interruption on blood pressure and heart rate after myocardial infarction in the ABYSS trial.
Does interruption of β-blocker treatment affect blood pressure, heart rate, and cardiovascular outcomes in patients after an uncomplicated myocardial infarction?
RCT (n=3,698)
randomized
Does interruption of β-blocker treatment affect blood pressure, heart rate, and cardiovascular outcomes in patients after an uncomplicated myocardial infarction?
Answers are grounded in this paper and cite their sources.
Interruption of beta-blocker therapy after an uncomplicated myocardial infarction leads to sustained increases in blood pressure and heart rate, and may worsen clinical outcomes, particularly in patients with baseline hypertension.
BACKGROUND AND AIMS: This study aims to report the effects of β-blocker interruption on blood pressure (BP) and heart rate (HR) in the AβYSS trial where patients were randomized to interruption or continuation of β-blocker treatment after a myocardial infarction (MI). METHODS: Changes in HR and BP from baseline to post-randomization are reported using linear mixed repeated model, in the 3698 patients of the AβYSS trial with a median follow-up of 3.0 years. Additionally, changes in HR and BP and the impact on the primary endpoint (death, MI, stroke, hospitalization for cardiovascular reason) in the pre-specified subgroups of patients with or without history of hypertension were assessed using linear mixed repeated and adjusted Cox proportional hazards model, respectively. RESULTS: β-blocker interruption was associated with significant increase {least square mean difference [95% confidence interval (CI)]} in systolic BP [+3.7 (2.6, 4.8) mmHg, P < .001], diastolic BP [+3.3 (2.6, 4.0) mmHg, P < .001], and resting HR [+10 [9, 11) b.p.m., P < .001] at 6 months that persisted over the duration of follow-up despite an increase in antihypertensive drugs in the β-blocker interruption group. The effects were observed in both hypertensive (43% of the population) and non-hypertensive patients. Hypertensive patients were at higher risk of events (25.8% vs. 19.2%) as compared with patients without hypertension (adjusted hazard ratio 1.18, 95% CI 1.01-1.36, P = .03). Patients with hypertension had a particularly marked increase in the primary endpoint (risk difference 5.02%, 0.72%-9.32%, P = .014) when randomized to β-blocker interruption. CONCLUSIONS: Interruption of β-blocker treatment after an uncomplicated MI led to a sustained increase in BP and HR, with potentially deleterious effects on outcomes, especially in patients with history of hypertension.
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Procopi et al. (2025) conducted an RCT in myocardial infarction (n=3,698). β-blocker interruption vs. continuation of β-blocker treatment was evaluated on death, MI, stroke, hospitalization for cardiovascular reason (Risk difference 5.02% (hypertensive subgroup), 95% CI 0.72-9.32, p=.014). Interruption of β-blockers after MI increased systolic blood pressure (+3.7 mmHg; P<0.001) and increased the primary endpoint in hypertensive patients (risk difference 5.02%; 95% CI 0.72-9.32; P=0.014).
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