| [Türkçe] | |
|
 |
| Turkish Society of Cardiology Young Cardiologists Bulletin Year: 8 Number: 3 / 2025 |
|
Prepared by: Dr. Serkan Bulguroğlu Name of the Study: Beta-blocker interruption effects on blood pressure and heart rate after myocardial infarction: the AßYSS trial Published in Congress: EURO PCR 2025 Linkhttps://doi.org/10.1093/eurheartj/ehaf170 IntroductionThe role of ß-blockers in stable coronary patients with preserved LVEF after uncomplicated myocardial infarction (MI) remains uncertain, though they may offer prognostic benefits through heart rate (HR) and blood pressure (BP) control. The AßYSS trial reports here the secondary results that showing the effect of ß-blocker interruption or continuation on haemodynamics (HR and BP) in the two randomized groups. It also provides the analysis of the primary and secondary outcomes of the AßYSS trial in the pre-specified subgroups of patients with or without a prior history of hypertension. ObjectiveThis study aims to report the effects of ß-blocker interruption on BP and HR in the AßYSS trial where patients were randomized to interruption or continuation of ß-blocker treatment after a MI. Methods Changes in HR and BP from baseline to post-randomization are reported using linear mixed repeated model, in the 3698 patients of the AßYSS trial with a median follow-up of 3.0 years. Additionally, changes in HR and BP and the impact on the primary endpoint (death, MI, stroke, hospitalization for cardiovascular reason) in the pre-specified subgroups of patients with or without history of hypertension were assessed using linear mixed repeated and adjusted Cox proportional hazards model, respectively. Resultsß-blocker interruption was associated with significant increase {least square mean difference [95% confidence interval (CI)]} in systolic BP [+3.7 (2.6, 4.8) mmHg, P < .001], diastolic BP [+3.3 (2.6, 4.0) mmHg, P < .001], and resting HR [+10 [9, 11) b.p.m., P < .001] at 6 months that persisted over the duration of follow-up despite an increase in antihypertensive drugs in the ß-blocker interruption group. The effects were observed in both hypertensive (43% of the population) and non-hypertensive patients. Hypertensive patients were at higher risk of events (25.8% vs. 19.2%) as compared with patients without hypertension (adjusted hazard ratio 1.18, 95% CI 1.01–1.36, P = .03). Patients with hypertension had a particularly marked increase in the primary endpoint (risk difference 5.02%, 0.72%–9.32%, P = .014) when randomized to ß-blocker interruption. ConclusionsInterruption of ß-blocker treatment after an uncomplicated MI led to a sustained increase in BP and HR, with potentially deleterious effects on outcomes, especially in patients with history of hypertension. CommentaryInterruption of ß-blocker treatment beyond 6 months in stable patients with a prior myocardial infarction led to a significant and sustained increase in systolic and diastolic BP and HR. This loss of BP and HR control following ß-blocker interruption may partially explain the results of the AßYSS trial and expose patients to potential deleterious long-term effects on outcomes, especially in patients with a prior history of hypertension.
|
| 2025 © Turkish Society of Cardiology. |