Objectives: To 1) consider the problem of sudden death from heart disease and the role of β-blockers and other agents in preventing sudden death and 2) review perceived problems with β-blocker therapy, such as effects on blood lipids, complications in diabetes, and adverse effects on heart failure and quality of life.
Data Sources: MEDLINE and EMBASE searches done from July 1994 on, and recognized texts.
Study Selection: More than 400 original and review articles were evaluated, of which the most relevant were selected.
Data Extraction: Data were extracted and reviewed by two authors. Accuracy was confirmed, when necessary, by the other authors.
Data Synthesis: Of all of the therapies currently available for the prevention of sudden cardiac death, none is more established or more effective than β-blockers. Indeed, the evidence that β-blockers have a cardioprotective effect is compelling. They probably reduce the rate of atheroma formation; they reduce the risk for ventricular fibrillation in animal models of myocardial ischemia; they appear to reduce cardiac mortality in primary prevention trials; and they reduce mortality, particularly from sudden death, in patients who have had infarction. Moreover, withholding β-blockers because of problems perceived to be associated with them is usually not warranted and may frequently prevent their use in those who will benefit most from them.
Conclusion: Clinicians should reappraise the evidence for the significant effect of β-blockers on morbidity and mortality, and they should recognize the importance of initiating and maintaining β-blocker therapy when the less well-informed might suggest other-wise.