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Beta Blockers Raise Stroke, Death Risk After Surgery
Date:5/13/2008

heart disease, compared with those receiving a placebo. In addition, those taking a beta blocker were 27 percent less likely to have a heart attack than patients receiving a placebo.

But, more people taking a beta blocker died than those taking a placebo. In fact, patients taking a beta blocker had a 33 percent increased risk of dying compared with patients taking a placebo.

Also, there were more strokes among people taking a beta blocker than among patients receiving a placebo. Those receiving the beta blocker had double the risk of suffering a stroke compared with patients receiving a placebo, the researchers reported.

The most likely explanation for the increase in deaths and stroke among those taking beta blockers was that these patients could go into shock if their blood pressure were too low, a not uncommon complication of surgery, Devereaux said. "If they were on the beta blockers they were in big trouble, and [it] increased their likelihood of dying or suffering a stroke," he said.

Devereaux doesn't think reducing the risk of heart attack is worth increasing the risk of stroke or death. "I don't think most patients would be willing to accept the excess death and excess stroke for preventing a heart attack," he said.

Using a beta blocker to prevent heart attacks in these patients is not the right strategy, Devereaux said. "If we are causing so much harm to prevent heart attacks, we need to find another solution which will prevent these events, but not have the same risk."

One expert thinks that the doses of beta blockers given in the trial were too high.

"The increase in hypotension [low blood pressure] and resulting strokes and cardiovascular deaths may be a result of this overly aggressive dosing rather than perioperative beta blocker therapy in general," said Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles.

"While further studies
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