What You Need to Know about the Beta-Blocker Controversy

Beta-blockers are all over the news today, thanks to the publication of a new study in the USA.  The study was focused on patients with heart trouble, but there’s little doubt that it will impact migraine patients as well.

When it comes to heart disease, beta-blockers are prescribed in order to slow rapid heart beat and lower blood pressure.  They’re often prescribed to patients who have a previous history of heart attack or stroke, to patients with high blood pressure, and to patients who have just had a heart attack or have heart failure.

And, as we’ll see, it’s prescribed for conditions such as migraine and anxiety.

Beta-blockers have been a standard treatment for heart conditions for decades, and are commonly recommended in countries such as the USA, Canada, Australia, and in Europe.

So when the researchers reviewed how much help the drugs were to patients, you would think they would see a significant benefit.  Or – a fair benefit?

Surprising Results

The study concluded (as quoted by Forbes):

Among patients enrolled in the international REACH registry, beta-blocker use was not associated with a lower event rate of cardiovascular events at 44-month follow-up, even among patients with prior history of MI. Further research is warranted to identify subgroups that benefit from beta-blocker therapy and the optimal duration of beta-blocker therapy…

In other words, the beta-blockers did not seem to prevent further heart “events”, such as heart attack!

This was no small study.  Data was analyzed from 44,000 patients.  And the differences between those on beta-blockers and not on beta-blockers tended to be slight.

Take for example those coronary artery disease.  13.6% of those not on beta-blockers had a heart attack, stroke, or died from heart disease within 44 months.  12.9% of those on beta-blockers were the same.  A difference of only 0.7%, and not statistically significant.

Among people just at high risk, 12% not on beta-blockers had a “bad outcome” within 44 months, and 14.2% on beta-blockers!  That’s right, in this case there was a slightly higher risk for those actually taking the drug.

Another recent review of 8,912 people led to a similar result.  The researchers led by Dr. Jim Wright of the University of British Columbia in Canada found that those with hypertension taking beta-blockers did not have a lower mortality rate than those not on the drug.

Doctors Cautious

Naturally, with a treatment as well-entrenched as beta-blockers, doctors are not quick to make a change.  First of all, this study was simply an analysis of the available data, and couldn’t take into consideration other factors that may have impacted the outcome.

One of the most important variables that you might miss in the news is that beta-blockers are taken at different times for different things.  Most are still suggesting that there’s more than enough evidence to continue to prescribe beta-blockers right after a heart attack, for example.

And patients are urged NOT to stop taking beta-blockers without talking to their doctor.  They may have very good reason to take them.

On the other hand, many may not.  And the cost of taking beta-blockers for months and years – when the side effects may be worse than the benefits – could be staggering.

Migraine Patients Need to Know

So what does this have to do with migraine patients?  Well, migraineurs generally take beta-blockers for migraine symptoms as a preventative.  We’re not sure how beta-blockers change the migraine chain-reaction, but we do know that for many people they reduce their attacks quite significantly.

Doctors are already cautious about prescribing beta-blockers to migraine patients who also have a heart condition.  However, there are times when certain patients may take a beta-blocker for migraine and hypertension.

Migraine patients are also believed to be at higher risk for stroke and heart attack, which may lead some doctors to try beta-blockers before other treatments.

But this approach may need to be re-evaluated.  For some, the side effects of beta-blockers (such as fatigue, dizziness and nocturna) may no longer be worth it.  Others may want to look into medications that are more likely to help with their condition.

Now that generic versions of beta-blockers are available, there are likely to be fewer high-powered expensive studies done.  Then again, maybe we’ll start seeing studies that are more objective.

Read more:  Blood pressure drug benefits overestimated for mild cases
Beta Blockers May Not Prevent Heart Attacks and Strokes