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Randomized Controlled Trial
. 2025 Aug 1;46(29):2894-2902.
doi: 10.1093/eurheartj/ehaf170.

Beta-blocker interruption effects on blood pressure and heart rate after myocardial infarction: the AβYSS trial

Niki Procopi  1 , Michel Zeitouni  1 , Mathieu Kerneis  1 , Guillaume Cayla  2 , Emile Ferrari  3 , Grégoire Range  4 , Etienne Puymirat  5   6 , Nicolas Delarche  7 , Paul Guedeney  1 , Farzin Beygui  8 , Laurent Desprets  9 , Jean-Louis Georges  10 , Thomas Bochaton  11 , François Schiele  12 , Grégory Ducrocq  13 , Marie Hauguel-Moreau  14 , Raphaelle Dumaine  15 , Michel S Slama  16 , Laurent Payot  17 , Mohamad El Kasty  18 , Karim Aacha  1 , Abdourahmane Diallo  19 , Xavier Girerd  1 , Eric Vicaut  19 , Johanne Silvain  1 , Gilles Montalescot  1
Affiliations
Randomized Controlled Trial

Beta-blocker interruption effects on blood pressure and heart rate after myocardial infarction: the AβYSS trial

Niki Procopi et al. Eur Heart J. .

Erratum in

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.

Keywords: Beta-blockers; Blood pressure; Heart rate; Myocardial infarction; Outcome.

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