Beta blockers in sihd

Dr. Amit VoraMumbai

Obviously in selected Patients

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JAMA. 2012;308(13):1340-1349

JAMA. 2012;308(13):1340-1349

JAMA. 2012;308(13):1340-1349

JAMA. 2012;308(13):1340-1349

Huang, Fox KA. Scottish Medical Journal 2012;57:69-75

The Ochsner Journal 13:166–168, 2013

Prior MICAD, no MICAD RF only

Circ Cardiovasc QualOutcomes 2014;7:1-11

“Beta-blocker use at discharge in patients with stable angina withoutprior history of MI or systolic HF undergoing elective PCI was notassociated with any decrease in mortality, revascularization and re-hospitalization related to MI or stroke at 30-days and 3-years follow-up,” Parikh concluded. “Over time, prescriptions of beta-blockers atdischarge have continued to increase in this population despite oflack of clearly demonstrated objective benefits.”

Adverse effects of beta-blockers

1. All post MI pts, up to 3 years

2. All patients with LVEF < 0.40

1. Fails to reduce central aortic pressure

2. Increase in unfavorable metabolic consequence – DM, dyslipidemia

3. Unable to provide benefit in the era of thrombolysis & revascularization / anti-platelets / ACE-I / Statins

4. Not well tolerated and poor adherence to Rx

NB: 4th line of Rx in hypertension

1. Post MI group (up to 3 years)

2. CHF with LV systolic dysfunction

?? may consider for angina relief