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

Niki Procopi; Michel Zeitouni; Mathieu Kerneis; Guillaume Cayla; Emile Ferrari; Grégoire Range; Etienne Puymirat; Nicolas Delarche; Paul Guedeney; Farzin Beygui; Laurent Desprets; Jean-Louis Georges; Thomas Bochaton; François Schiele; Grégory Ducrocq; Marie Hauguel-Moreau; Raphaelle Dumaine; Michel S Slama; Laurent Payot; Mohamad El Kasty; Karim Aacha; Abdourahmane Diallo; Xavier Girerd; Eric Vicaut; Johanne Silvain; Gilles Montalescot

doi:10.1093/eurheartj/ehaf170

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

Eur Heart J. 2025 May 22:ehaf170. doi: 10.1093/eurheartj/ehaf170. Online ahead of print.

Authors

Niki Procopi¹, Michel Zeitouni¹, Mathieu Kerneis¹, Guillaume Cayla², Emile Ferrari³, Grégoire Range⁴, Etienne Puymirat^{5

6}, Nicolas Delarche⁷, Paul Guedeney¹, Farzin Beygui⁸, Laurent Desprets⁹, Jean-Louis Georges¹⁰, Thomas Bochaton¹¹, François Schiele¹², Grégory Ducrocq¹³, Marie Hauguel-Moreau¹⁴, Raphaelle Dumaine¹⁵, Michel S Slama¹⁶, Laurent Payot¹⁷, Mohamad El Kasty¹⁸, Karim Aacha¹, Abdourahmane Diallo¹⁹, Xavier Girerd¹, Eric Vicaut¹⁹, Johanne Silvain¹, Gilles Montalescot¹

Affiliations

¹ Sorbonne Université, Hôpital Pitié-Salpêtrière (AP-HP), ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, 83 blvd de l'Hôpital, 75013 Paris, France.
² ACTION Study Group, Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France.
³ Service de Cardiologie, Université Côte d'Azur, CHU de Nice, Hôpital Pasteur 1, Nice, France.
⁴ Service de Cardiologie, Centre Hospitalier de Chartres, Hôpital Louis Pasteur, Le Coudray, France.
⁵ Cardiovascular Department, Hôpital Européen Georges-Pompidou, Université Paris-Cité, Paris, France.
⁶ Paris Cardiovascular Research Center, Inserm UMR_U970, Université Paris-Cité, Paris, France.
⁷ Department of Cardiology, Centre Hospitalier de Pau, Pau, France.
⁸ Service de Cardiologie, CHU de Caen Normandie, 14000 Caen, France.
⁹ Service de Cardiologie, Centre Hospitalier de Cholet, Cholet, France.
¹⁰ Department of Cardiology, Centre Hospitalier de Versailles, André Mignot Hospital, Le Chesnay-Rocquencourt, France.
¹¹ Intensive Cardiological Care Division, Hospices Civils de Lyon-Hôpital Cardiovasculaire et Pulmonaire, Laboratoire CarMeN-IRIS Team, INSERM, Université Claude Bernard Lyon-1, Bron, France.
¹² Department of Cardiology, Université de Franche-Comté, SINERGIES, Besançon, France.
¹³ Cardiology Department, Hôpital Bichat, AP-HP, 46 Rue Henri Huchard, 75018, Paris, France.
¹⁴ ACTION Study Group, Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France.
¹⁵ Les Grands Prés Cardiac Rehabilitation Department, 27 Rue Sainte-Christine, 77174 Villeneuve St Denis, France.
¹⁶ Reference Center for Cardiac Amyloidosis, Cardiology Department, APHP Bichat Hospital, CRMR NNERF, Paris, France.
¹⁷ Cardiology Department, General Hospital Yves Le Foll, 10 Rue Marcel Proust, 22000 Saint-Brieuc, France.
¹⁸ Département de Cardiologie, Grand Hôpital de l'Est Francilien site Marne-La-Vallée, Marne-la-Vallée, France.
¹⁹ Unité de Recherche Clinique Lariboisière St Louis, ACTION Group, Hôpital St-Louis & Fernand Widal, Paris, France.

PMID: 40401436
DOI: 10.1093/eurheartj/ehaf170

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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Abstract

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