THE ROLE OF BETA BLOCKERS IN MANAGEMENT OF CAD, IN 2012

Beta blockers is a group of drugs that we are all so familiar with. It was in 1962 that Sir James Black discovered that drugs act by attaching to receptors, and initiating their actions. Dr Black was largely credited with the discovery of the receptor concept for drug action, and the discovery of Propranolol. Of course h receive the Nobel Prize for Medicine in 1988, 26 years later.
Anyway, since then beta blockers have been used for the treatment of many conditions from CAD / AMI to tremors and migraine.
When I went for my MRCP, beta blockers were wonderful drugs that can be used in hypertension, prevention of AMI, prevention of complications after an MI, management of angina, management of abdominal aneurysms  and later in the 80s, in the management of heart failure.
Now in the 21st century, where does beta blocker stand?
A recent paper by Dr Sripal Bangalore ( New York University School of Medicine, examined this issue. He and colleagues looked in to the REACH ( Reduction of Atherothrombosis for Continued Health database of 44,708 patients, across 44 countries. They separated those on beta blockers into Gp 1 - those with prior MI, GP 2- those with CAD without previous MI and GP 3, those with severe coronary risk factors. These were divided into two arms ( those on beta blockers and those not on beta blockers ). All patients were followed for 44 months. Primary end point were Cardiovascular deaths, non-fatal MI and non fatal strokes.
He found that essentially there was no difference between these 3 groups, whether they were beta blocked or not. Both groups did as well. These findings tell us that the use of beta blockers in patients with prior MI, patients with CAD but no prior MI and those with severe coronary risk factors, have no benefit, after 44 months.
We also know that beta blockers have also fallen out of favour in the managememnt of hypertension, following the Ascot BP arm.
So essentially in the 21st century, the role of beta blockers is confined to treatment of angina pectoris, management of AMI, and management of heart failure.