Beta-blockers in Cardiovascular Disease: Do not throw out the baby with the bathwater.

1 Three decades ago, prior to the use of anti-platelets and reperfusion therapy for patients with myocardial infarction (MI), intravenous beta-blocker was shown to produce a small although clinically significant benefit in reducing the combined end-point of death, cardiac arrest or reinfarction . Subsequently, a review of 29,260 patients in 51 short term trials showed that early beta-blocker use in MI did not significantly reduce mortality (OR 0.96, 95%CI 0.85-1.08) . However, amongst 24,974 patients in 31 long term trials, beta-blocker use was associated with a highly significant reduction in all cause mortality (OR 0.77, 95%CI 0.69-0.85). Amongst the older beta-blockers studied in those trials, propranolol, timolol and metoprolol appeared to be most beneficial. Despite the clear evidence of benefit, beta-blockers remain underutilised through the 1990’s even in the United States with only between 21-58 % of eligible MI patients receiving therapy at hospital discharge, and only about 10% receiving adequate doses .