Discontinuation of Beta-Blockers Risky in Post-MI Patients with Preserved LVEF and Hypertension: ABYSS trial

A new study published in the European Heart Journal showed that patients with myocardial infarction (MI) and preserved left ventricular ejection fraction (LVEF) who discontinue beta-blocker therapy experience notable increases in heart rate and blood pressure. This physiological response is associated with a heightened risk of adverse outcomes, especially in individuals with pre-existing hypertension.

In the coronary artery disease patients, β-blockers regulate blood pressure (BP) and heart rate (HR), which may be prognostic variables. However, the use of β-blockers to treat hypertension is becoming more and more controversial, and their antihypertensive effects are less important than their cardiovascular preventive properties.

And so, Niki Procopi and colleagues carried out this investigation to document the impact of stopping β-blocker treatment on blood pressure and heart rate in the AβYSS experiment, in which patients were randomly assigned to either stopping or continuing β-blocker therapy following a myocardial infarction.

The AβYSS study included 3698 participants with a median follow-up of 3.0 years. Changes in HR and BP from baseline to post-randomization are reported using a linear mixed repeated model. Additionally, the linear mixed repeated and adjusted Cox proportional hazards models were used to evaluate changes in HR and BP as well as the impact on the primary endpoint (death, MI, stroke, and hospitalization for cardiovascular reasons) in the pre-specified subgroups of patients with or without a history of hypertension.

Despite an increase in antihypertensive medications in the β-blocker interruption group, β-blocker interruption was linked to a significant increase in systolic blood pressure [+3.7 (2.6, 4.8) mmHg, P <.001], diastolic blood pressure [+3.3 (2.6, 4.0) mmHg, P <.001], and resting heart rate [+10 [9, 11) b.p.m., P <.001] at 6 months.

These changes continued throughout the follow-up period. Both hypertension patients (43% of the population) and non-hypertensive individuals experienced the effects. When compared to individuals without hypertension, those with hypertension had a greater risk of events (25.8% vs. 19.2%) (adjusted hazard ratio 1.18, 95% CI 1.01–1.36, P =.03).

When randomized to β-blocker interruption, patients with hypertension saw a notably significant rise in the main outcome (risk difference 5.02%, 0.72%–9.32%, P =.014). Overall, the AβYSS study results may be partially explained by this loss of BP and HR control after β-blocker cessation, which also exposes patients to potentially harmful long-term consequences on outcomes, particularly in those with a history of hypertension.

Source:

Procopi, N., Zeitouni, M., Kerneis, M., Cayla, G., Ferrari, E., Range, G., Puymirat, E., Delarche, N., Guedeney, P., Beygui, F., Desprets, L., Georges, J.-L., Bochaton, T., Schiele, F., Ducrocq, G., Hauguel-Moreau, M., Dumaine, R., Slama, M. S., Payot, L., … Montalescot, G. (2025). Beta-blocker interruption effects on blood pressure and heart rate after myocardial infarction: the AβYSS trial. European Heart Journal. https://doi.org/10.1093/eurheartj/ehaf170