Secondary prevention with beta-adrenoceptor blockers in post-myocardial infarction patients

Staessen, Jan A.; Bulpitt, CJ; Cattaert, A; Fagard, Robert; Vanhees, Luc; Améry, A

doi:10.1016/0002-8703(82)90184-3

Cited by 15 publications

(8 citation statements)

References 13 publications

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“…investigators 60,61 did not consider the large body of evidence available from secondary prevention trials of myocardial infarction, published Ͼ2 decennia ago 63 and confirmed recently. 64 If not for stroke, ␤-blockers should remain within the first-line therapeutic arsenal for the prevention of myocardial infarction and sudden death in patients with a history of coronary heart disease.…”

Section: Observed Versus Predicted Odds Ratios For Stroke By Between-mentioning

confidence: 99%

“…64 If not for stroke, ␤-blockers should remain within the first-line therapeutic arsenal for the prevention of myocardial infarction and sudden death in patients with a history of coronary heart disease. 63,64 Remarkably, in the EUROPA trial, 55 perindopril only offered protection against myocardial infarction in patients already on ␤-blockers.…”

Section: Observed Versus Predicted Odds Ratios For Stroke By Between-mentioning

confidence: 99%

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Blood Pressure Lowering for Primary and Secondary Prevention of Stroke

2006

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H ypertension affects from 20% to 30% of the world population. 1,2 Blood pressure is the most consistent and powerful predictor of stroke. Population mortality trends for stroke parallel those in hypertension. 3,4 A systolic blood pressure Ͼ115 mm Hg explains 60% of the population-attributable risk of stroke. 5 In the Framingham cohort, 6 the lifetime risk of stroke at ages 55, 65, and 75 years was similar, approximating 1 in 5 for women and 1 in 6 for men. In many countries, such as China, 7 stroke is the third cause of death only preceded by heart disease and total cancer. Two thirds of stroke deaths occur in developing nations. 8 According to recent estimates published by the World Health Organization, worldwide, Ϸ15 million people per year fall victim to a stroke, of whom Ϸ5 million die and another Ϸ5 million are left permanently disabled. 1 From this vantage point, we reviewed the recent literature to underscore the deadly but reversible link between stroke and blood pressure. Role of Blood Pressure Among Other Risk Factors Nonmodifiable Risk FactorsNonwhite ethnicity, male sex, older age, and a positive family history are among the nonmodifiable risk factors of stroke. 9,10 Monogenic stroke disorders, 11 such as, for instance, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, 12 are extremely rare. In the vast majority of cases, stroke has a polygenic background associated with proven or suspected variation in the genes contributing to hypertension, carotid intima-media thickness, vascular remodeling, small vessel disease, 13 inflammation, oxidative stress, dyslipidemia, or the generation of angiotensin II. 14,15 Small vessel disease of the brain underlies 20% to 30% of ischemic strokes and a larger proportion of intracerebral hemorrhages. 13 Modifiable Risk FactorsSmoking, 1,9,10 excessive alcohol intake (Ͼ60 g per day), 9,10,16 obesity, 9,10 dyslipidemia, 9,10 diabetes mellitus, 9,17 carotid artery disease, 9,10 atrial fibrillation, heart failure, and other forms of heart disease 1,9 are treatable risk factors for stroke.However, among the modifiable risk indicators, high blood pressure has by far the largest impact. 1,9 In a quantitative overview of 61 cohort studies, the Prospective Studies Collaboration demonstrated a strong log-linear relation without threshold between stroke mortality and blood pressure (Figure 1A), starting at levels of 115 mm Hg systolic and 75 mm Hg diastolic and consistent across the age range (50 to 89 years). 18 At ages 40 to 69 years, each difference in blood pressure of 20 mm Hg systolic or 10 mm Hg diastolic was associated with a Ͼ2-fold difference in stroke mortality. 18 More recently, the Asian Pacific Cohort Studies Collaboration reported that in both sexes systolic blood pressure ( Figure 1B) tended to be more predictive than diastolic blood pressure in all age groups with the exception of men Ͻ50 years. 19,20 Stroke Prediction From Automated Blood Pressure MeasurementsProspective observational 21,22 and intervention 23 studies ...

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Section: Observed Versus Predicted Odds Ratios For Stroke By Between-mentioning

confidence: 99%

Section: Observed Versus Predicted Odds Ratios For Stroke By Between-mentioning

confidence: 99%

Blood Pressure Lowering for Primary and Secondary Prevention of Stroke

2006

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“…In some b-blocker trials, investigators withdrew a substantial number of patients because of bradycardia -a sign of effective b-blockade [53]. One cannot dismiss the large body of evidence available from the secondary prevention trials of myocardial infarction [54], published more than two decades ago, and recently confirmed in Chinese [55]. If not for stroke, b-blockers should remain within the first-line therapeutic arsenal for the prevention of myocardial infarction and sudden death in patients with a history of coronary heart disease.…”

Section: Avoiding Metabolic Side Effectsmentioning

confidence: 99%

???Beyond blood pressure??? means multiple risk factor intervention, not pleiotropic antihypertensive drugs

Staessen

Thijs²,

Li³

et al. 2007

Current Opinion in Cardiology

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From 150,000 to 180,000 randomized patients followed up from 3 to 5 years were required to demonstrate a 10-15% benefit 'beyond blood pressure lowering' of newer antihypertensive drugs, such as calcium channel blockers or angiotensin-converting enzyme inhibitors in the prevention of cause-specific cardiovascular complications. Assuming an absolute risk of new-onset diabetes mellitus on older drugs of approximately 10% over 5 years and a relative benefit on the newer drugs of approximately 30%, about 100 patients would have to be treated for 5 years with the newer agents to avert approximately three iatrogenic cases of diabetes. Whether or not new-onset diabetes is associated with increased risk is uncertain. In most patients, optimization of treatment at acceptable tolerance requires rotation through and combination of several drug classes. Combination of different classes of antihypertensive drugs not only enhances the blood pressure-lowering efficacy, but likely decreases the risk of metabolic adverse effects as well. True benefit beyond blood pressure lowering in hypertensive patients comes from multiple risk factor intervention.

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“…28 It may therefore not be surprising that only 10% of patients with systolic blood pressure less than 160 mmHg and at relatively low risk (risk level II) were under pharmacological treatment. However, prevalence of treatment was still less than 50% in patients with mild isolated systolic hypertension and associated clinical conditions, despite the evidence that patients with coronary heart disease, chronic heart failure, and high-risk patients in general, [29][30][31][32] would benefit from blood-pressurelowering drugs. The SHEP, 4 Syst-Eur 5 and Syst-China 6 trials have convincingly shown that antihypertensive therapy reduces the incidence of cardiovascular complications in patients with moderate-to-severe (grade X2) isolated systolic hypertension.…”

Section: Treatment Of Isolated Systolic Hypertension Rh Fagard and M mentioning

confidence: 99%

Treatment and blood pressure control in isolated systolic hypertension vs diastolic hypertension in primary care

Enden

2003

J Hum Hypertens

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Cross-sectional surveys on prevalence, treatment and control of hypertension could not satisfactorily distinguish between diastolic hypertension and isolated systolic hypertension because the definition of hypertension included patients under pharmacological treatment. We assessed the situation in the two types of hypertension in general practice in Belgium, based on current blood pressure (BP) measurements and on BP prior to the initiation of drug therapy. Participating physicians enrolled the first 15 at least 55-year-old men visiting the surgery, measured their BP and recorded data on medical history including pretreatment BP, drug utilization, cardiovascular risk factors and target organ damage. Diastolic hypertension was defined as diastolic BPX90 mmHg, irrespective of systolic BP, and isolated systolic hypertension as systolic BPX140 mmHg and diastolic BPo90 mmHg. Among 3761 evaluable patients, 74% were hypertensive. Among the 1533 hypertensive patients in whom blood pressure was known prior to treatment (n ¼ 965) or who were untreated at the study visit (n ¼ 568), 1164 had diastolic hypertension and 369 isolated systolic hypertension. The prevalence of antihypertensive treatment was, respectively, 75 and 25% (Po0.001) in these two types of hypertension. The odds of being treated were independently determined by type of hypertension, severity of hypertension and level of risk (Po0.001). BP was controlled in 25% of all patients with diastolic hypertension and in 13% of all patients with isolated systolic hypertension (Po0.001). About half of the treated patients with systolic hypertension were on a diuretic and/or a calcium-channel blocker. In conclusion, isolated systolic hypertension is less frequently treated than diastolic hypertension, overall BP control is poor and actual drug therapy diverges from recommendations based on placebo-controlled intervention trials.

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Secondary prevention with beta-adrenoceptor blockers in post-myocardial infarction patients

Cited by 15 publications

References 13 publications

Blood Pressure Lowering for Primary and Secondary Prevention of Stroke

Blood Pressure Lowering for Primary and Secondary Prevention of Stroke

???Beyond blood pressure??? means multiple risk factor intervention, not pleiotropic antihypertensive drugs

Treatment and blood pressure control in isolated systolic hypertension vs diastolic hypertension in primary care

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