Beta-blocker interruption effects on blood pressure and heart rate after myocardial infarction: the AβYSS trial

Beta-blocker interruption effects on blood pressure and heart rate after myocardial infarction: the AβYSS trial
Eur Heart J 2025 Aug 1;46(29):2894-2902. doi: 10.1093/eurheartj/ehaf170.

Abstract

Background and aims: This study aims to report theeffects of β-blocker interruption on blood pressure (BP) and heart rate (HR) in the AβYSS trial where patients were randomized to interruption or continuation of β-blocker treatment after a myocardial infarction (MI).

Methods: Changes in heart rate and blood pressurefrom baseline to post-randomization are reported using linear mixed repeated model, in the 3698 patients of the AβYSS trial with a median follow-up of 3.0 years. Additionally, changes in heart rate and blood pressure and the impact on the primary endpoint (death, MI, stroke, hospitalization for cardiovascular reason) in the pre-specified subgroups of patients with or without history of hypertension were assessed using linear mixed repeated and adjusted Cox proportional hazards model, respectively.

Results: β-blocker interruption was associated withsignificant increase {least square mean difference [95% confidence interval (CI)]} in systolic BP [+3.7 (2.6, 4.8) mmHg, P <.001], diastolic BP [+3.3 (2.6, 4.0) mmHg, P < .001], and resting heart rate [+10 [9, 11) b.p.m., P < .001] at 6 months that persisted over the duration of follow-up despite an increase in antihypertensive drugs in the β-blocker interruptiongroup. The effects were observed in both hypertensive (43% of the population) and non-hypertensive patients. Hypertensive patients were at higher risk of events (25.8% vs. 19.2%) as compared with patients without hypertension (adjusted hazard ratio 1.18, 95% CI 1.01-1.36, P = .03). Patients with hypertension had a particularly marked increase in the primary endpoint (risk difference 5.02%, 0.72%-9.32%, P = .014) when randomized to β-blocker interruption.

Conclusions: Interruption of β-blocker treatment after an uncomplicated myocardial infarction led to a sustained increase in blood pressure and heart rate with potentially deleterious effects on outcomes, especially in patients with history of hypertension.

Disclaimer:

Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.