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).
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?
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.
Effect estimate: Risk difference 5.02% (hypertensive subgroup) (95% CI 0.72-9.32)
p-value: p=.014
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.
Procopi et al. (Thu,) conducted a 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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