When to use beta-blockers.

Beta-blockers are recommended for heart failure and for secondary prevention after a recent myocardial infarction (MI). Doctors should think twice before prescribing these drugs to other highrisk groups, say researchers. Adults with a remote history of MI, those with cardiovascular disease but no history of MI, and those with just cardiovascular risk factors did not seem to benefit from beta-blockers in a large observational study (N=21 860). Treatment was not associated with a lower risk of cardiovascular death, non-fatal MI or stroke in fully adjusted analyses, and the authors found no evidence of cardiovascular benefit over four years in any of the three patient groups. They did confirm a lower risk of all cardiovascular events combined in a subgroup of adults with a recent MI.

Current practice is underpinned by old evidence that accumulated before modern reperfusion therapies and cardioprotective drug protocols, say the authors. Beta-blockers may not be as effective for many patients as was previously thought. International guidelines are already being revised.

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Bangalore S, et al. JAMA 2012;308(13):1340-1349. [http://dx.doi.org/10.1001/jama.2012.12559]