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A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results
Insights
The beta-Blocker Heart Attack Trial (BHAT) demonstrated that propranolol significantly reduced total mortality in patients post-myocardial infarction. This beta-blocker therapy is recommended for at least three years for eligible heart attack survivors.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Post-myocardial infarction (MI) management aims to reduce mortality.
- Beta-blockers are a class of drugs used to manage cardiovascular conditions.
Purpose of the Study:
- To evaluate the efficacy of propranolol hydrochloride in reducing total mortality after myocardial infarction.
- To assess the impact of beta-blocker therapy on arteriosclerotic heart disease (ASHD) mortality and sudden cardiac death.
Main Methods:
- A multicenter, randomized, double-blind, placebo-controlled trial (BHAT) involving 3,837 patients aged 30-69.
- Participants received either propranolol (180-240 mg/day) or placebo 5-21 days post-MI.
- Follow-up averaged 24 months, with the trial stopped early due to efficacy.
Main Results:
- Total mortality was lower in the propranolol group (7.2%) compared to placebo (9.8%).
- ASHD mortality (6.2% vs. 8.5%) and sudden cardiac death (3.3% vs. 4.6%) were also reduced with propranolol.
- Common side effects included hypotension, GI issues, and fatigue, but serious adverse events were infrequent.
Conclusions:
- Regular administration of propranolol hydrochloride significantly reduces total mortality in patients who have had a myocardial infarction.
- Propranolol is recommended for at least three years for post-MI patients without contraindications to beta-blockade.
- The BHAT trial provides strong evidence for the life-saving benefits of beta-blockers after heart attack.
Abstract:
The beta-Blocker Heart Attack Trial (BHAT) was a National Heart, Lung, and Blood Institute-sponsored, multicenter, randomized, double-blind, and placebo-controlled trial designed to test whether the regular administration of propranolol hydrochloride to men and women who had experienced at least one myocardial infarction would result in a significant reduction in total mortality during a two- to four-year period. During a 27-month interval, 3,837 persons between the ages of 30 and 69 years were randomized to either propranolol (1,916 persons) or placebo (1,912 persons), five to 21 days after the infarction. Depending on serum drug levels, the prescribed maintenance dose of propranolol hydrochloride was either 180 or 240 mg/day. The trial was stopped nine months ahead of schedule. Total mortality during the average 24-month follow-up period was 7.2% in the propranolol group and 9.8% in the placebo group. Arteriosclerotic heart disease (ASHD) mortality was 6.2% in the propranolol group and 8.5% in the placebo group. Sudden cardiac death, a subset of ASHD mortality, was 3.3% among the propranolol patients and 4.6% among the placebo patients. Serious side effects were uncommon. Hypotension, gastrointestinal problems, tiredness, bronchospasm, and cold hands and feet occurred more frequently in the propranolol group. Based on the BHAT results, the use of propranolol in patients with no contraindications to beta-blockade who have had a recent myocardial infarction is recommended for at least three years.