Beta-Adrenergic Blockers for Acute Myocardial Infarction: 50 years of Expert Opinions in Cecil Textbook of Medicine

BACKGROUND: The beta-adrenergic blocker propranolol was synthesized in 1964 by James Black working at the Imperial Chemical Industries in England. The drug did not demonstrate encouraging effects regarding mortality of patients with acute myocardial infarction in clinical trials published in the 1960s in Great Britain and soon thereafter in other countries, but seemed promising after very large studies were conducted in the 1980s in the United States and elsewhere. STUDY QUESTION: What are the milestones of the beta-adrenergic blocker use recommended by experts for the pharmacological management of acute myocardial infarction in the United States? STUDY DESIGN: To determine the changes in the experts' approach to the management of acute myocardial infarction regarding the use of beta-adrenergic blockers as presented in a widely used textbook in the United States. DATA SOURCES: The chapters describing the management of acute myocardial infarction in the 15 editions of Cecil Textbook of Medicine updated by recognized experts for clinicians from 1967 through 2020. RESULTS: Beta-adrenergic blockers such as propranolol, timolol, and metoprolol were first mentioned in Cecil Textbook of Medicine in 1985 and recommended unreservedly in Cecil Medicine only since 2000. The record suggests that the expert opinions were shaped by large clinical trials published in the United States in the early 1980s. CONCLUSIONS: The decades long delay in the change in the experts' opinion regarding the utility of beta-adrenergic blockers in acute myocardial infarction in the United States is an instance of prudence and well-tempered clinical judgment.