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

Niki Procopi1, Michel Zeitouni1, Mathieu Kerneis1

  • 1Sorbonne Université, Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, 83 blvd de l'Hôpital, 75013 Paris, France.

European Heart Journal
|May 22, 2025
PubMed

Insights

Stopping beta-blocker therapy after myocardial infarction increases blood pressure and heart rate. This interruption poses risks, particularly for patients with a history of hypertension.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Pharmacology

Background:

  • Beta-blockers are standard treatment post-myocardial infarction (MI).
  • The AβYSS trial investigated the impact of beta-blocker interruption versus continuation after MI.

Purpose of the Study:

  • To evaluate the effects of beta-blocker interruption on blood pressure (BP) and heart rate (HR) post-MI.
  • To assess the impact of beta-blocker interruption on cardiovascular outcomes, especially in patients with hypertension.

Main Methods:

  • A randomized trial (AβYSS) involving 3698 patients post-MI.
  • Linear mixed-effects models analyzed changes in BP and HR over a median 3.0-year follow-up.
  • Cox proportional hazards models assessed outcomes in subgroups based on hypertension history.

Main Results:

  • Beta-blocker interruption significantly increased systolic BP (+3.7 mmHg), diastolic BP (+3.3 mmHg), and HR (+10 bpm) at 6 months, persisting throughout follow-up.
  • These effects were observed in both hypertensive and non-hypertensive patients.
  • Hypertensive patients experienced a higher risk of primary events (death, MI, stroke, cardiovascular hospitalization) and a marked increase in primary endpoint risk with beta-blocker interruption.

Conclusions:

  • Interruption of beta-blocker treatment after MI causes sustained increases in BP and HR.
  • Beta-blocker withdrawal may have adverse effects on cardiovascular outcomes, particularly in patients with a history of hypertension.
Abstract

Keywords:
Beta-blockersBlood pressureHeart rateMyocardial infarctionOutcome

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