| Abstract: | The objective of the Beta-Blocker Pooling Project (BBPP) wasto collect and analyse data from the major long-term secondaryprevention trials in order to determine whether there are subsetsof post-infarction patients who benefit to a greater or lesserextent from beta-blocker therapy than the average patient population. One-year all-cause mortality data from nine trials involving13 679 patients were obtained. Overall, mortality was 24% lowerin the beta-blocker group compared to the placebo group. However,there was heterogeneity among the results of the trials, whichtested seven different beta-blockers. Subgroups with high placebogroup mortality (e.g. patients with a history of previous myocardialinfarction (MI), angina pectoris, mechanical or electrical complications,and digitalis usage) seemed to benefit particularly from beta-blockertreatment. These findings were consistent in the nine trials.Patients in the lower risk subgroups also appeared to benefitfrom beta-blockers, but this benefit was smaller in absoluteterms and inconsistent across the trials. There was no evidencethat treatment outcome was related to gender, baseline levelof heart rate or blood pressure, or time of initiation of treatmentafter hospital admission. In conclusion, the Pooling Projectindicates that high risk MI patients, without contraindicationsto beta-blockers, are the prime candidates for long-term therapy,but the lower risk patients may also receive some benefit. |
