Stopping Beta-Blockers After MI Raises BP, HR, and Risks in Hypertensives, suggests study

The AβYSS trial involved 3,698 patients with uncomplicated myocardial infarction and a median follow-up period of 3.0 years. Patients were randomly allocated to either continue or stop β-blocker treatment. Changes in systolic and diastolic blood pressure and resting heart rate were determined by researchers by applying a linear mixed repeated model. The researchers also evaluated the effect of these changes on a composite primary outcome including death, recurrent MI, stroke, or hospitalization for cardiovascular causes. Subgroup analysis was also aimed at identifying differences in patients with versus without a previous history of hypertension, utilizing an adjusted Cox proportional hazards model to compare outcome risks.

Results

• Patients who stopped β-blocker treatment had an increased cardiovascular parameter at six months after randomization.

• The least square mean difference (95% CI) of systolic BP was +3.7 mmHg (2.6, 4.8; P < .001), whereas diastolic BP increased by +3.3 mmHg (2.6, 4.0; P < .001).

• Moreover, there was a significant increase in resting HR by +10 beats per minute [9, 11); P < .001]. T

• these changes continued during follow-up, even with increased use of other antihypertensive medications in the β-blocker interruption group.

• Effects were observed in both hypertensive and non-hypertensive subjects.

• Yet, 43% of the trial group had a history of hypertension, and these patients reflected a very high susceptibility.

• In hypertensive patients, the event rate was 25.8% versus 19.2% in non-hypertensives.

• The hazard ratio for poor outcomes in patients with hypertension was 1.18 (95% CI 1.01–1.36; P = .03) after adjustment.

• Among hypertensive patients who were randomized to β-blocker withdrawal, the risk of reaching the primary endpoint was 5.02% higher (95% CI 0.72%–9.32%; P = .014), which represents a clinically significant increase in cardiovascular risk.

The AβYSS trial concludes that discontinuation of β-blocker therapy after an uncomplicated myocardial infarction creates a sustained increase in blood pressure and heart rate, with particularly deleterious effects in hypertensive patients. These observations underscore the importance of individualized cardiovascular treatment and raise the possibility that ongoing β-blocker therapy might be advantageous for selected high-risk subgroups even after clinical stabilization. Discontinuation decisions should consider both hemodynamic alterations and long-term cardiovascular risk patterns.

Reference:

Niki Procopi, Michel Zeitouni, Mathieu Kerneis, Guillaume Cayla, Emile Ferrari, Grégoire Range, Etienne Puymirat, Nicolas Delarche, Paul Guedeney, Farzin Beygui, Laurent Desprets, Jean-Louis Georges, Thomas Bochaton, François Schiele, Grégory Ducrocq, Marie Hauguel-Moreau, Raphaelle Dumaine, Michel S Slama, Laurent Payot, Mohamad El Kasty, Karim Aacha, Abdourahmane Diallo, Xavier Girerd, Eric Vicaut, Johanne Silvain, Gilles Montalescot, on behalf of the AβYSS Investigators of the ACTION Study Group, Beta-blocker interruption effects on blood pressure and heart rate after myocardial infarction: the AβYSS trial, European Heart Journal, 2025;, ehaf170, https://doi.org/10.1093/eurheartj/ehaf170