[Beta blockers in secondary prevention following acute heart infarct]

Prospective studies have confirmed a preventive effect of beta-adrenergic agents in the early as well as the late postinfarction period. In the early postinfarction period (first week), mortality is decreased by 13% by a lower incidence of myocardial ruptures and by stabilization of the size of the infarcted area. Prevention of reinfarction and sudden cardiac death in the late period of secondary prevention (up to six years) leads to additional reduction of mortality by 22 to 35%, depending on the risk group. The preventive effect of beta-blocking agents is not only attributed to their anti-ischemic properties but also to their antihypertensive, antiarrhythmic and antithrombotic effects. Beta-1-selective and not selective blockers show preventive effects. Beta-1-selective blockers are preferred because of fewer side effects. The effect of partially agonistic beta-blocking agents is low and thus of no use for secondary prevention. The elimination pathway and the price should be considered in the choice of the beta-blocking drug.