Beta Blockers May Improve Mortality in Combo Therapy

Beta blockers plus angiotensin-receptor blockers safe, effective after heart attack

20 july 2009-- Therapy combining beta blockers with angiotensin-receptor blockers improves survival among patients with heart failure after myocardial infarction, without adverse interactions affecting prognosis, according to a study in the July 15 American Journal of Cardiology.

Robert M. Califf, M.D., of the Duke Translational Medicine Institute in Durham, N.C., and colleagues studied 14,703 patients with myocardial infarction and heart failure or left ventricular systolic dysfunction who were randomized to receive valsartan, captopril, or both, and beta blockers. The researchers compared outcomes for patients treated with beta blockers at admission and hospital discharge, at admission only, at discharge only, and neither.

The researchers found that the study groups treated with beta blockers both before randomization and at discharge had a three-year mortality rate of 17.7 percent compared to 30.7 percent for those treated only before randomization and 25.9 percent for those treated only at discharge. The study group that did not receive beta blockers at all had the highest mortality (35.1 percent). The researchers discerned no interaction between beta blockers and valsartan or valsartan and captopril together.

"These results have further confirmed that beta blockers reduce the risk of death and nonfatal cardiovascular events in patients with heart failure or systolic left ventricular dysfunction after myocardial infarction," the authors write. "In conclusion, no evidence was found of adverse interactions between the angiotensin-receptor blocker valsartan and beta blockers or of a negative effect of the combination of valsartan, captopril, and beta blockers."

Abstract
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