The effect of γ-adrenoreceptive antagonists on the morbidity and mortality in cardiovascular disease

Abstract

The effect is critically reviewed of chronic administration of beta-adrenoreceptor antagonists on morbidity and mortality in angina pectoris and myocardial infarction. There is inconclusive evidence that the abrupt cessation of therapy with these agents may increase morbidity and mortality in angina pectoris. The type of anginal patient in which this may occur is not yet defined and neither is the mechanism. There is no evidence that beta-antagonists prolong the life of anginal patients. In the acute phase of experimental myocardial infarction, these drugs reduce mortality but do not do so in man. There is increasing evidence that they prolong life if administered to patients surviving the acute phase of myocardial infarction. The need for further studies is discussed.

The management of hypertension.

“…Overall trials of ,3-adrenoceptor blocking drugs post-infarction indicate the drugs produce benefit (Baber & Lewis, 1982;Hampton, 1982;Lancet, 1982;Rose, 1982;Turi & Braunwald, 1983), although like all drugs, there is a benefit risk ratio (Breckenridge, 1982). A number of the studies can be criticized on methodological grounds (Fitzgerald, 1976;Hampton, 1981) and there have been some negative results (Baber et al, 1980;Wilcox etal., 1980) but there have now been numerous reports that indicate ,B-adrenoceptor blocking drugs are effective in reducing the recurrence rate of myocardial infarction (Ahlmark et al, 1974;Wilhelmsen et al, 1973;Multicentre International Study, 1975;Hjalmarson et al, 1981;Norwegian Multicenter Study Group, 1981;BHAT 1982;Hansteen et al, 1982;Julian et al, 1982). This evidence and that for there being an effect in acute myocardial infarction suggests that there is a cardioprotective effect in high risk patients following myocardial infarction.…”

The second Lilly Prize Lecture, University of Newcastle, July 1977. beta‐Adrenergic receptor blockade in hypertension, past, present and future.

“…It has been shown that various P-adrenergic receptor blocking drugs reduce the ECG changes associated with ischaemia at rest and on exercise (Prichard, Aellig & Richardson, 1970 Although a number of the studies can be criticized on methodological grounds (Fitzgerald, 1976), a number of studies in post infarction patients have suggested that there is a reduction in recurrence of myocardial infarction and or sudden death in those patients given P-adrenergic receptor blocking drugs (Wilhelmsson, Vedin, Wilhelmsen, Tibblin & Werko, 1974;Ahlmark, Saetre & Korsgren, 1974;Multicentre Trial, 1975). A similar effect has been observed in patients with angina pectoris (Lambert, 1976).…”

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“…Although a number of the studies can be criticized on methodological grounds (Fitzgerald, 1976), a number of studies in post infarction patients have suggested that there is a reduction in recurrence of myocardial infarction and or sudden death in those patients given P-adrenergic receptor blocking drugs (Wilhelmsson, Vedin, Wilhelmsen, Tibblin & Werko, 1974;Ahlmark, Saetre & Korsgren, 1974;Multicentre Trial, 1975). A similar effect has been observed in patients with angina pectoris (Lambert, 1976).…”