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1 September 1995 | Volume 123 Issue 5 | Pages 358-367
Objectives: To 1) consider the problem of sudden death from heart disease and the role of ß-blockers and other agents in preventing sudden death and 2) review perceived problems with ß-blocker therapy, such as effects on blood lipids, complications in diabetes, and adverse effects on heart failure and quality of life.
Data Sources: MEDLINE and EMBASE searches done from July 1994 on, and recognized texts.
Study Selection: More than 400 original and review articles were evaluated, of which the most relevant were selected.
Data Extraction: Data were extracted and reviewed by two authors. Accuracy was confirmed, when necessary, by the other authors.
Data Synthesis: Of all of the therapies currently available for the prevention of sudden cardiac death, none is more established or more effective than ß-blockers. Indeed, the evidence that ß-blockers have a cardioprotective effect is compelling. They probably reduce the rate of atheroma formation; they reduce the risk for ventricular fibrillation in animal models of myocardial ischemia; they appear to reduce cardiac mortality in primary prevention trials; and they reduce mortality, particularly from sudden death, in patients who have had infarction. Moreover, withholding ß-blockers because of problems perceived to be associated with them is usually not warranted and may frequently prevent their use in those who will benefit most from them.
Conclusion: Clinicians should reappraise the evidence for the significant effect of ß-blockers on morbidity and mortality, and they should recognize the importance of initiating and maintaining ß-blocker therapy when the less well-informed might suggest other-wise.
Author and Article Information
From Queen Elizabeth Hospital, Birmingham, United Kingdom; Sahlgren's Hospital, Gothenburg, Sweden; and The National Hospital and the University of Oslo, Oslo, Norway.
REVIEW
ß-Blockers and Sudden Cardiac Death
Grant Support: In part by an educational grant from Astra Hassle, Molndal, Sweden.
Requests for Reprints: Martin J. Kendall, Clinical Pharmacology Section, Department of Medicine, Queen Elizabeth Hospital, Birmingham M15 2TH, United Kingdom.
Current Author Addresses: Drs. Kendall and Lynch: Clinical Pharmacology Section, Department of Medicine, Queen Elizabeth Hospital, Birmingham M15 2TH, United Kingdom.
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