Beta blockers can be lifesavers – don’t give them up just yet

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 the UK take the drugs, not just after a heart attack, but for heart rhythm problems, high blood pressure and anxiety. and I fear there will be too many who misinterpret this, and think, right, I didn’t want to be on beta blockers anyway, and just stop taking them.

and yet these drugs can be — and are — lifesaving.

If you missed it, a quick recap: the story came from a major conference in the U.S., hosted by the american College of Cardiology.

a prestigious gathering, no doubt, while the research itself has just been published in the also prestigious New england Journal of Medicine. two ticks.

the study involved 5,000 recent heart attack patients who were either given beta blockers or no treatment. they were followed up after three-and-a-half years and the results showed that in about half the patients on the beta blockers, the treatment did not reduce their risk of another heart attack or dying prematurely.

In some ways this finding isn’t so new. In the past ten years reviews have suggested that beta blockers made no difference to some patient outcomes — but that they do have a place when carefully and properly prescribed.

and worse: a previous study found heart attack patients given beta blockers were more likely to have a stroke at some stage.

But in my view the risk was that people who had a heart attack were already at risk of a stroke, not due to the drugs but because of whatever had led to their heart attack in the first place.

So what does this mean for you?

First, I should explain how beta blockers work. essentially they interfere with adrenaline and other hormones that raise your heart rate and blood pressure, so reducing strain on the heart.

that’s why they’re given to heart attack patients, about half of whom will later develop heart failure — where damage to the heart caused by the heart attack means it’s unable to pump blood efficiently around the body. It becomes weaker and weaker, causing symptoms such as breathlessness and fluid retention, and raising the risk of early death.

It’s these heart failure patients who did benefit from beta blockers, according to the new study.

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

and they’re prescribed to patients with abnormal heart rhythms such as rapid atrial fibrillation (where the heart beats erratically and fast), which, like heart failure, are very common.

Beta blockers are given for anxiety, too — and high blood pressure. the problem particularly with the latter is you might not have symptoms until you experience a cardiovascular problem, such as a heart attack or stroke.

For this reason, people are notoriously quick to quit taking hypertension drugs, as they can’t see the point because they have no symptoms.

My worry is that these and other patients who really need the drugs see this story, and stop taking this important medication.

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

the topline of the study is powerful. however, there are several caveats about the findings. For instance, we don’t know how long the patients on beta blockers actually took them (the researchers only had this information for the first year). and maybe, like people on blood pressure pills, they didn’t feel any different, and stopped taking them.

there also wasn’t a placebo arm to the trial, and the trial wasn’t ‘blinded’, the gold standard for new treatments (this is where patients are randomised to have either the treatment being tested, or a placebo: and they and their doctors don’t know which they’re getting), even though we know the placebo effect is strong.

as an aside, the study has been criticised for only 22.5 per cent of participants being women. the fact is cardiovascular disease is one of the biggest killers of women, and it’s not good enough these days that the researchers have apparently said other studies are similarly skewed.

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

and research has found that medical treatment for angina, coronary heart disease and after a heart attack (with statins/aspirin/beta blockers etc) is just as effective at preventing premature death as surgery to insert a stent, or a heart bypass.

the bottom line is, as always, definitely do not take yourself off medication — in this case, beta blockers — without discussing it with your doctor first.