Sudden death: Risk reduction with ß-blockade
- 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.