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β Blockade after myocardial infarction

BMJ 2000; 320 doi: (Published 26 February 2000) Cite this as: BMJ 2000;320:581

βBlockade after myocardial infarction

  1. Sarah L Nuttall, research associate (,
  2. Veronica Toescu, research associate,
  3. Martin J Kendall, professor of clinical pharmacology
  1. Clinical Pharmacology Section, Department of Medicine, Queen Elizabeth Hospital, Birmingham B15 2TH
  2. Westerhope Medical Group, Westerhope, Newcastle upon Tyne NE5 2LH

    EDITOR—Freemantle et al show good evidence that long term — blockade is an effective and well tolerated treatment that reduces mortality and morbidity in unselected patients after myocardial infarction.1 They present data for the end points all cause mortality and non-fatal reinfarction but make no specific reference to sudden death. They quote the results of 31 long term trials; we have been able to find data on sudden death in only 13 of these.

    Sudden death is common and an important cause of death in the major long term trials after myocardial infarction. In the 13 trials that included data on sudden death the average incidence of sudden death in the placebo treated group was 51% (table). The corresponding figure in the groups treated with a β blocker was 43%. Although this suggests that β blockers do reduce the risk of sudden death, these mean figures probably grossly underestimate …

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