A randomized trial of propranolol in patients with acute myocardial infarction. II. Morbidity results

The beta-Blocker Heart Attack Trial (BHAT) was a placebo-controlled, randomized, double-blind clinical trial of the long-term administration of propranolol hydrochloride to persons who had had at least one confirmed myocardial infarction. Among 3,837 patients followed up for an average of 25 months, coronary incidence, defined as recurrent nonfatal definite reinfarction plus fatal coronary heart disease, in the propranolol group was 10.0%, compared with 13.0% in the placebo group, a reduction of 23%. The incidence of definite nonfatal reinfarction was lower by 15.6%, and that of definite or probable nonfatal reinfarction by 14.7%. Among patients with a history of congestive heart failure (CHF), 14.8% of the propranolol-treated patients experienced definite CHF during the study, as did 12.6% of the placebo-treated patients. Among patients without history of CHF, the percentages experiencing CHF were 5.0% and 5.3%, respectively. In patients with no history of angina, the incidence of angina was 35.7% in the propranolol group and 34.4% in the placebo group. Among those who had a history of angina, the incidence was 66% in both groups. The BHAT analyses of nonfatal events reinforce the previous recommendation for the use of propranolol in the treatment of patients who have had a recent myocardial infarction and who have no contraindications to beta-blockers.

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