Beta Blocker Heart Attack Trial - BHAT

Description:

Propranolol for 2-4 year mortality after myocardial infarction.

Hypothesis:

The regular administration of propranolol hydrochloride to men and women who have experienced at least one MI would result in a significant reduction in total mortality during a 2 to 4 year period.

Study Design

Study Design:

Patients Screened: 1,400
Patients Enrolled: 3,837
Mean Follow Up: 25.1 months
Mean Patient Age: 54.8
Female: 16

Patient Populations:

Men and women aged 30 through 69 years
Hospitalized with acute MI documented by appropriate symptoms, ECG, and enzymatic changes

Exclusions:

Medical contraindications to propranolol, such as marked bradycardia
A history of severe congestive heart failure or asthma as an adult
A life-threatening illness other than coronary heart disease (CHD)
Had or were likely to have cardiac surgery
Were taking, or were likely to have taken β-blockers

Primary Endpoints:

Total mortality

Secondary Endpoints:

CHD mortality
Sudden cardiac death
CHD plus definite nonfatal MI

Drug/Procedures Used:

Propranolol hydrochloride 80mg (18%) or 60mg (82%) tid, depending on serum propranolol level.

Concomitant Medications:

Except as indicated, no significant difference between propranolol group and controls:
Vasodilators
Diuretic
Tranquilizer
Aspirin prescribed on a continuing basis
Antiarrhythmics (p < .001)
Potassium
Antihypertensives, excluding diuretics
Anticoagulant
Dipyridamole
Insulin
Hormonal
Oral hypoglycemic (p < 0.001)
Sulfinpyrazone
Lipid-lowering

Principal Findings:

Mortality
Total mortality was 7.2% in the propranolol group and 9.8% in the placebo group.
Ateriosclerotic heart disease (ASHD) mortality was 6.5% in the propranolol group and 8.5% in the placebo group.
Mortality from sudden cardiac death, a subset of ASHD, was 3.3% in propranolol patients and 4.6% among placebo patients.
Serious side effects were uncommon.

Morbidity
Coronary incidence (recurrent nonfatal definite reinfarction plus fatal CHD) was 10% for the propranolol group, compared with 13% in the placebo group, a reduction of 23%.
Incidence of definite nonfatal reinfarction was lower by 15.6%, and that of definite or probable nonfatal reinfarction was 14.7%.

Interpretation:

Based on BHAT results, in conjunction with those of studies reported previously, the investigators recommend the use of propranolol for at least three years in the treatment of patients who have had a recent MI and who have no contraindications to b-blockers.

References:

1. JAMA 1982; 247: 1707-1714. Final mortality results
2. JAMA 1983; 250: 2814-2819. Final morbidity results
3. Ann Intern Med 1993; 118:99-105. Long-term efficacy

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias

Keywords: Myocardial Infarction, Propranolol, Electrocardiography, Death, Sudden, Cardiac


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