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β-Blockers and Sudden Cardiac Death

Martin J. Kendall, MD, FRCP; Kevin P. Lynch, MBBS; Ake Hjalmarson, MD, PhD; and John Kjekshus, MD, PhD
[+] Article, Author, and Disclosure Information

From Queen Elizabeth Hospital, Birmingham, United Kingdom; Sahlgren's Hospital, Gothenburg, Sweden; and The National Hospital and the University of Oslo, Oslo, Norway. Grant Support: In part by an educational grant from Astra Hassle, Molndal, Sweden. Requests for Reprints: Martin J. Kendall, Clinical Pharmacology Section, Department of Medicine, Queen Elizabeth Hospital, Birmingham M15 2TH, United Kingdom. Current Author Addresses: Drs. Kendall and Lynch: Clinical Pharmacology Section, Department of Medicine, Queen Elizabeth Hospital, Birmingham M15 2TH, United Kingdom.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(5):358-367. doi:10.7326/0003-4819-123-5-199509010-00007
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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.


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Figure 1.
Sudden cardiovascular deaths in hypertensive patients.[17]

Reproduced with permission from American Journal of Hypertension .

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Figure 2.
Cumulative number of sudden deaths reported in five postinfarction trials.[30]

Reproduced with permission from the European Heart Journal .

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Figure 3.
Effect of β-blocker therapy on mortality and reinfarction rates in patients with and without diabetes after myocardial infarction, expressed as percentage reduction compared with patients receiving placebo.

Adapted from data in references 90 and 91.

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Figure 4.
Cumulative history (Hx) of congestive heart failure (CHF) by previous history of CHF and by treatment group.[98]

Adapted with permission from Circulation .

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Figure 5.
Effect of propranolol on morbidity and mortality related to the presence or absence of congestive heart failure (CHF).[98]

Adapted with permission from Circulation .

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