Beta-Blockers after Myocardial Infarction — For Few Patients, or Many?

During the 1960s, Sir James W. Black developed propranolol, which the Nobel Committee in 1988 called “the greatest breakthrough when it comes to pharmaceuticals against heart illness since the discovery of digitalis 200 years ago.”1 Black recognized that an agent that blocked the cardiac effects of epinephrine might reduce ischemia and lower the risk of death by decreasing the heart's demand for oxygen. A series of elegant randomized clinical trials reported in the 1980s confirmed the value of Black's insight by showing that beta-blockers improve survival after myocardial infarction.2 In order to focus on the potential therapeutic benefit of beta-blockers, . . .