Low-Dose Beta Blockers: When Less Is More

Beta blockers may help heart attack patients even in low doses

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Beta blockers are a class of medications often prescribed to patients after a heart attack. But the dosing for this medication has remained controversial.

A new study from Northwestern University found that the dose of beta blockers prescribed to heart attack patients can likely be significantly reduced without sacrificing effectiveness. In fact, patients on low doses may live just as long — or even longer — as patients on higher doses.

Jeffrey Goldberger, MD, a professor of cardiology at Northwestern University, launched this study when he noticed that many patients were being treated with lower doses of beta blockers than those typically used in clinical trials.

Dr. Goldberger was concerned that patients were receiving poor care, but the results of this study suggested otherwise.

"I thought that was terrible quality of care," Dr. Goldberger said in a press release. "We set out on a mission to show if you treat patients with the doses that were used in the clinical trials, they will do better. We expected to see patients treated with the lower doses to have worse survival. We were shocked to discover they survived just as well, and possibly even better."

Beta blockers (brand names Tenormin, Lopressor, Toprol–XL and Corgard) help protect the heart from the effects of adrenaline (a stress hormone) and decrease the risk of arrhythmia (irregular heartbeat). These drugs also help prevent heart failure.

For this study, Dr. Goldberger and team looked at 6,682 heart attack patients, 90 percent of whom were prescribed a beta blocker upon release from the hospital.

While all of the patients who took beta blockers survived longer than those who didn't, patients on lower doses survived the longest.

Nearly 15 percent of patients taking a full beta blocker dose died within two years. At one-quarter of the dose, however, only 9.5 percent died within two years.

"There is probably not one right dose for every single patient," Dr. Goldberger said. "It doesn't make sense that the same dose will work for an 80-year-old frail man who had a small heart attack as a burly 40-year-old man with a huge heart attack. Since this is medicine we use in every single heart attack patient, we ought to figure out how to use it properly."

This study was published Sept. 21 in the Journal of the American College of Cardiology.

The National Heart, Lung, and Blood Institute funded this research. No conflicts of interest were disclosed.

Reviewed by: 
Review Date: 
September 22, 2015
Last Updated:
September 24, 2015