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Medicines optimisation

Low dose beta blockers as effective as high dose after heart attack

Patients who received target doses of beta blocker therapy after a heart attack did not have improved survival over patients receiving lower doses. In the image, propranolol beta-blocker drug crystals

Source: Sidney Moulds / Science Photo Library

Beta blocker therapy, such as propranolol (crystals pictured), is often given at doses established in early clinical trials rather than at the optimal dose for individual patients

Beta blocker therapy is given to almost all patients who have had a myocardial infarction (MI), with the dose often based on those established in early clinical trials. However, no large-scale study has addressed the effects of beta blocker dose on survival.

Writing in the Journal of the American College of Cardiology[1] (2015;66(13):1431–1441), Chicago-based researchers describe how the OBTAIN (outcomes of beta blocker therapy after myocardial infarction) study collected beta blocker dosing information for 6,682 patients who had an MI.

The researchers expected higher doses of beta blocker to be associated with increased post-MI survival. But it was patients who received a quarter of the dose established in earlier trials that had up to a 25% increase in survival compared with those who received higher doses.

Future research will now attempt to establish the optimal dose of beta blocker for individual patients.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20069409

Readers' comments (2)

  • Was this an rct, cohort study, case control? I'd expect a professional journal to make at least some mention of the type of study.

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  • The study was an observational multicentre registry study - further details can be found via the hyperlink provided, which also links to a useful audio commentary.

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Supplementary images

  • Patients who received target doses of beta blocker therapy after a heart attack did not have improved survival over patients receiving lower doses. In the image, propranolol beta-blocker drug crystals

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