Beta-blockers and sudden cardiac death

Ann Intern Med. 1995 Sep 1;123(5):358-67. doi: 10.7326/0003-4819-123-5-199509010-00007.


Objectives: To 1) consider the problem of sudden death from heart disease and the role of beta-blockers and other agents in preventing sudden death and 2) review perceived problems with beta-blocker therapy, such as effects on blood lipids, complications in diabetes, and adverse effects on heart failure and quality of life.

Data sources: MEDLINE and EMBASE searches done from July 1994 on, and recognized texts.

Study selection: More than 400 original and review articles were evaluated, of which the most relevant were selected.

Data extraction: Data were extracted and reviewed by two authors. Accuracy was confirmed, when necessary, by the other authors.

Data synthesis: Of all of the therapies currently available for the prevention of sudden cardiac death, none is more established or more effective than beta-blockers. Indeed, the evidence that beta-blockers have a cardioprotective effect is compelling. They probably reduce the rate of atheroma formation; they reduce the risk for ventricular fibrillation in animal models of myocardial ischemia; they appear to reduce cardiac mortality in primary prevention trials; and they reduce mortality, particularly from sudden death, in patients who have had infarction. Moreover, withholding beta-blockers because of problems perceived to be associated with them is usually not warranted and may frequently prevent their use in those who will benefit most from them.

Conclusion: Clinicians should reappraise the evidence for the significant effect of beta-blockers on morbidity and mortality, and they should recognize the importance of initiating and maintaining beta-blocker therapy when the less well-informed might suggest otherwise.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenergic beta-Antagonists / adverse effects
  • Adrenergic beta-Antagonists / therapeutic use*
  • Anti-Arrhythmia Agents / therapeutic use
  • Coronary Disease / mortality
  • Coronary Disease / prevention & control
  • Death, Sudden, Cardiac / prevention & control*
  • Diabetes Complications
  • Humans
  • Lipids / blood
  • Quality of Life
  • Ventricular Fibrillation / prevention & control


  • Adrenergic beta-Antagonists
  • Anti-Arrhythmia Agents
  • Lipids