Significance of “beta blocker rebound phenomenon” and new suggestions how to avoid it

When beta adrenergic receptor blocker (BB) is stopped abruptly, tachycardia, blood pressure raise, increased number of anginal attacks, worsening of HF symptoms, etc. may ensue, which is known as “BB rebound phenomenon”. Thus, the aim of the paper is four-fold: to review the topic (BB rebound phenomenon); to illustrate BB rebound presence in everyday practice; to provide Guidelines’ view on BB rebound, and to suggest possible preventive measures (including the new ones) to avoid BB rebound. The majority of papers confirmed it, most of the studies showed even increased mortality in patients with coronary artery disease, and some patients from clinical practice clearly had BB rebound. Even if we suppose that BB rebound is rare, it is important because millions of patients worldwide take BB on daily basis. Moreover, an adverse cardiac event as a manifestation of BB rebound is unpredictable, making prevention more needed and more difficult. Thus, BB rebound concept remains useful, serving to remind us to warn patients not to withdraw BB on their own, particularly if BB dose is high. Comprehensive guidelines without a single exception suggest avoidance of abrupt withdrawal of BBs (BB rebound). Aiming to prevent BB rebound more efficiently, in the addition to already published suggestions, we recommend that selective and vasodilatatory BBs should be preferred. They have fewer side effects generally, which makes certain better drug adherence, decreasing the likelihood of BB rebound. Underestimation of problems with such potentially lethal diseases as acute coronary syndrome, heart failure, arrhythmias, etc. (where BB is indicated and, if abruptly ceased, can lead to rebound) may have very serious consequences.