• Placebo-controlled studies have shown significant reductions in sudden death with b-blockade.

• Primary prevention. About 50% of men and 63% of women who die suddenly have no previous symptoms of coronary disease.¹

  - MAPHY (Metoprolol Atherosclerosis Prevention in Hypertensives) demonstrated a 30% reduction in sudden death in patients with mild-to-moderate uncomplicated hypertension who were treated initially with a b-blocker (metoprolol, mean dose 176 mg daily) compared with a diuretic.²

• Secondary prevention. The risk of sudden death is increased 4 to 6X in people who have had a heart attack.¹

  - Pooled results of five double-blind randomized studies that included more than 5000 post-MI patients show that b-blockade (metoprolol 100 mg twice daily) reduced sudden deaths 42% compared with placebo.³

• Heart failure. The risk of sudden death increases 6 to 9× with HF compared with the general population.¹

  - In the MERIT-HF study, b-blockade (ER metoprolol succinate 200 mg once daily) reduced sudden death 41%. The benefits of b-blockade were apparent within 2 months.⁴

¹American Heart Association. 2002 Heart and Stroke Statistical Update. Dallas, Tex: American Heart Association. 2001.

²Olsson G, Tuomilehto J, Berglund G, Elmfeldt D, Warnold I, Barber H, et al. Primary prevention of sudden cardiovascular death in hypertensive patients. Mortality results from the MAPHY Study. Am J Hypertens. 1991;4(2 Pt 1):151-158.

³Olsson G, Wikstrand J, Warnold I, Manger Cats V, McBoyle D, Herlitz J, et al. Metoprolol-induced reduction in postinfarction mortality: Pooled results from five double-blind randomized trials. Eur Heart J. 1992;13:28-32.

⁴MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999;353:2001-2007.