Beta blockers may be doing more harm than good for heart attack patients

UPPSALA, Sweden — Beta blockers may be causing more harm than good for heart attack patients, according to new research. These pills, which reduce blood pressure, do not improve survival chances for those who have not experienced heart failure, according to researchers in Sweden. They are now calling for large randomized clinical trials to determine if doctors should continue to prescribe these medications.

Dr. Gorav Batra, the corresponding author from Uppsala University in Sweden, says that in this large nationwide study, long-term beta-blocker therapy beyond the first year following a heart attack did not lead to a lower risk of cardiovascular health problem in patients without heart failure. Beta blockers were once among the most commonly prescribed blood pressure drugs but have fallen out of favor as newer, more effective medications have become available.

How do beta blockers work?

Beta blockers help widen veins and arteries to improve blood flow and can also help manage anxiety symptoms such as racing heart rate. They work by blocking stress hormones like adrenaline but can cause side-effects, including dizziness and tiredness. They are known to be beneficial for people with heart failure, a condition that often follows a heart attack and involves damaged heart muscle and reduced blood-pumping ability.

However, the researchers discovered that for those who suffered a heart attack without developing heart failure, beta blockers made no difference. Dr. Batra notes that the long-term use of beta blockers to reduce the risk of further heart attacks or death does not seem warranted in patients without heart failure.

The study found no difference between patients taking beta blockers more than a year after their heart attack and those not on the drugs. While beta blockers are predominantly used to manage abnormal heart rhythms and angina, they are also routinely prescribed after a heart attack to lower the risk of recurrence and other cardiovascular complications — a practice referred to as secondary prevention.

However, it remains unclear whether these drugs are necessary among patients with no signs of heart failure or a potentially fatal complication called left ventricular systolic dysfunction (LVSD) beyond the first year. Most current evidence is based on clinical trial results that predate major changes to the routine care of heart attack patients.

Scroll down to see 7 alternatives to taking beta blockers

Man suffering from heart attack
(© twinsterphoto – stock.adobe.com)

The study published in the journal Heart analyzed 43,618 older men and women in Sweden who experienced a heart attack between 2005 and 2016 that required hospital treatment. Their details were entered into a national health database, and they were tracked for an average of four and a half years. None had heart failure or LVSD, with 34,253 still on beta blockers a year after discharge and the remaining 9,365 never received a prescription for them.

The findings showed that long-term treatment with beta blockers was not associated with improved cardiovascular outcomes even after accounting for potentially aggravating factors such as demographics and other illnesses. Dr. Batra says that this study is the largest and most comprehensive of its kind, adding that ongoing randomized clinical trials will provide much-needed evidence about the role of long-term beta-blocker therapy in this patient group.

Cardiovascular disease is the world’s leading cause of death, claiming nearly 18 million lives each year.

“Despite strong evidence that long-term beta-blockers can improve outcomes after [heart attack], it has been uncertain whether this benefit applies to lower risk patients who are taking other evidence-based therapies and who have a [normal functioning heart],” says Professor Ralph Stewart and Dr. Tom Evans of Green Lane Cardiovascular Services in New Zealand in a media release.

“Recommendations on the duration of beta blocker therapy are variable or absent because this question was not specifically evaluated in clinical trials. Most patients take daily medications for many years after a [heart attack] because they believe they are beneficial,” the scientists point out in their editorial.

“[This] study raises an important question directly relevant to the quality of care—do patients with a normal [functioning heart] benefit from long term beta-blocker therapy after [heart attack]? To answer this question, more evidence from large randomized clinical trials is needed.”

Are there alternatives to taking beta blockers?

There are several alternatives to beta blockers for managing various health conditions. The choice of alternative medication depends on the specific condition being treated, and patients should always consult a healthcare professional before making any changes to a medication regimen. Some alternatives to beta blockers include:

  1. Angiotensin-converting enzyme (ACE) inhibitors: These medications help relax blood vessels by preventing the formation of angiotensin II, a substance that narrows blood vessels. ACE inhibitors are commonly prescribed for treating high blood pressure and heart failure.
  2. Angiotensin II receptor blockers (ARBs): Similar to ACE inhibitors, ARBs work by blocking the action of angiotensin II, resulting in the relaxation of blood vessels. They are often prescribed for high blood pressure and heart failure as well.
  3. Calcium channel blockers: These medications prevent calcium from entering the cells of the heart and blood vessel walls, which helps relax the blood vessels and reduce the workload on the heart. Calcium channel blockers are used for treating high blood pressure, angina, and certain types of arrhythmias.
  4. Diuretics (water pills): Diuretics help reduce the amount of fluid in the body by increasing the production of urine. They are often used to treat high blood pressure and heart failure.
  5. Vasodilators: These medications directly relax the smooth muscle of blood vessels, causing them to dilate and decrease blood pressure. Vasodilators can be used to treat high blood pressure and heart failure.
  6. Antiarrhythmic medications: For individuals requiring treatment for abnormal heart rhythms, alternative antiarrhythmic drugs can be considered, depending on the specific type of arrhythmia.
  7. Lifestyle changes: In some cases, making lifestyle modifications such as maintaining a healthy diet, exercising regularly, quitting smoking, reducing stress, and limiting alcohol consumption can help manage blood pressure and improve overall heart health, potentially reducing the need for medications.

It is important to note that medication choices depend on individual factors and the specific condition being treated. Always consult a healthcare professional before making any changes to your medication regimen.

South West News Service writer Mark Waghorn contributed to this report.

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