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Adverse events with beta-blockers major reason for discontinuation

By Nigel Praities

GPs are struggling to keep patients on beta-blockers because the drugs are so poorly tolerated by patients, a large analysis by UK researchers reveals.

As many as half of patients initiated on a beta-blocker stopped taking the drug within three years, the study of over 12,000 patient records from the UK general practice research database found.

Patients were prescribed a beta-blocker for indications including previous myocardial infarction, angina or heart failure, but 27% of patients had discontinued therapy even at one year.

Dr George Kassianos, an author of the study and a GP in Bracknell, Berkshire, said the study showed the management of patients with serious coronary conditions was inadequate.

‘We are not treating these patients adequately in primary care. We think we are a good job, but the patients end up not taking these incredibly important drugs. We need other options that are better tolerated,' he said.

Some 21% of patients with a myocardial infarction and 32% of those with angina discontinued beta-blocker therapy at one year, and 43% and 55% respectively at three years.

In a separate analysis, the researchers showed high rates of adverse events such as dyspnoea, fatigue and dizziness – with rates of 97.8, 52.9 and 48.8 per 1,000 patient years respectively.

These adverse events were a major reason for a reduction in dose or discontinuation of the therapy in a quarter of patients.

The research was presented at the European Society of Cardiology meeting in Barcelona, Spain, last weekend.

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