Beta-blocker interruption effects on blood pressure and heart rate after myocardial infarction: the AβYSS trial
Niki Procopi, Michel Zeitouni, Mathieu Kernéis, Guillaume Cayla, Émile Ferrari, Grégoire Rangé, Étienne Puymirat, Nicolas Delarche, Paul Guedeney, Farzin Beygui, Laurent Desprets, Jean‐Louis Georges, Thomas Bochaton, François Schiele, Grégory Ducrocq, Marie Hauguel‐Moreau, Raphaëlle Dumaine, Michel Slama, Laurent Payot, Mohamad El Kasty, Karim Aacha, Abdourahmane Diallo, Xavier Girerd, Éric Vicaut, Johanne Silvain, Gilles Montalescot
Abstract
BACKGROUND AND AIMS: This study aims to report the effects of β-blocker interruption on blood pressure (BP) and heart rate (HR) in the AβYSS trial where patients were randomized to interruption or continuation of β-blocker treatment after a myocardial infarction (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 AβYSS 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. RESULTS: β-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 β-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 β-blocker interruption. CONCLUSIONS: Interruption of β-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.