Why you should keep taking beta blockers: DR MARTIN SCURR dismisses concerns from a new study

My heart sank yesterday when I saw the story about beta blockers helping “only half of heart attack patients,” according to a new study.

Thousands of people in Britain use the drugs not only after a heart attack, but also for heart rhythm problems, high blood pressure and anxiety. And I’m afraid that there will be too many people who will misinterpret this and think: I didn’t want to be on beta blockers after all, and would just stop taking them.

And yet these medications can – and are – lifesaving.

In case you missed it, a quick recap: the story came from a major conference in the US organized by the American College of Cardiology.

Undoubtedly a prestigious meeting, while the research itself has just been published in the equally prestigious New England Journal of Medicine. Two taps.

The study involved 5,000 patients who had had a recent heart attack and were given beta blockers or no treatment. They were followed up after three and a half years and the results showed that in about half of the patients given beta blockers, the treatment did not reduce the risk of another heart attack or premature death.

In some ways, this finding isn’t all that new. Over the past decade, studies have suggested that beta blockers made no difference to some patient outcomes, but they do have a place if prescribed carefully and appropriately.

And even worse, an earlier study found that heart attack patients given beta blockers were more likely to have a stroke at some point.

But in my opinion, people who had a heart attack were already at risk for a stroke, not because of the drugs, but because of what led to their heart attack in the first place.

So what does this mean for you?

First I need to explain how beta blockers work. Essentially, they interfere with adrenaline and other hormones that increase your heart rate and blood pressure, reducing pressure on the heart.

That is why they are given to patients having a heart attack, about half of whom will later develop heart failure. Damage to the heart caused by the heart attack means that blood cannot be pumped around the body efficiently. It becomes weaker and weaker, causing symptoms such as shortness of breath and fluid retention, and increasing the risk of premature death.

According to the new study, it is these patients with heart failure who benefit from beta blockers.

But the drugs are also given to thousands of others with heart failure (caused, for example, by declining heart muscle function due to clogged arteries or damage from high blood pressure).

And they are prescribed to patients with abnormal heart rhythms, such as rapid atrial fibrillation (where the heart beats irregularly and quickly), which, like heart failure, is very common.

Beta blockers are also given for anxiety and high blood pressure. The problem, especially with the latter, is that you may not experience symptoms until you experience a cardiovascular problem, such as a heart attack or stroke.

Beta blockers work by interfering with adrenaline and other hormones that increase your heart rate and blood pressure, reducing pressure on the heart. That is why they are given to patients having a heart attack, about half of whom will later develop heart failure

For this reason, people have been known to quickly stop taking high blood pressure medications because they don’t see the point in taking them because they have no symptoms.

My concern is that these and other patients who really need the medicine see this story and stop taking this important medicine.

What about other heart attack patients in the new study who don’t have heart failure? Do they no longer need beta blockers?

The top line of the study is powerful. However, there are several caveats to the findings. For example, we don’t know how long the patients taking beta blockers actually took them (the researchers only had this information for the first year). And maybe, like people who took blood pressure pills, they didn’t feel any different and stopped taking them.

There was also no placebo arm in the study, and the study was not ‘blinded’, the gold standard for new treatments (this is where patients are randomized to either receive the treatment being tested or a placebo: and they and their doctors don’t know which one they’re getting), even though we know the placebo effect is strong.

As a side note, the study has been criticized because only 22.5 percent of participants were women. The fact is that cardiovascular disease is one of the biggest causes of death in women, and it is not good enough these days that researchers have apparently said that other studies are also skewed.

A major complaint about beta blockers is their side effects, including nausea and fatigue. In my clinical experience, modern beta blockers such as bisoprolol appear to be more or less free of side effects. Very rarely have I had to take a patient off the drug for this reason.

And research has shown that medical treatment for angina, coronary artery disease and after a heart attack (with statins/aspirin/beta blockers, etc.) is as effective in preventing premature death as stent insertion surgery or heart bypass .

The bottom line is that, as always, you should definitely not go off your medication (in this case the beta blockers) without first discussing it with your doctor.