Beta-blocking agents in cardiovascular disease; are they here to stay?

In the contemporary practice of treatment of myocardial infarction (MI), beta-blocking agents have no mortality benefit but they do reduce recurrent myocardial infarction (MI) and angina. However, this comes at the expense of an increase in heart failure, cardiogenic shock and drug discontinuation as shown by a recent meta-analysis published online in the American Journal of Medicine in June 2014 [1]. This metaanalysis involved 60 trials with 102,003 patients and the primary outcome was all-cause mortality. The authors concluded that clinical guidelines recommending the use of betablocking agents in post-MI patients need to be reconsidered. Consequently, debate has arisen regarding the efficacy of betablocking agents in MI and in other cardiovascular conditions. Let’s review some recent trials on the application of betablocking agents in patients with various cardiovascular diseases and under various circumstances.