POSTINFARCTION USE OF BETA-BLOCKERS IN ELDERLY PATIENTS

beta-Adrenoceptor antagonists (beta-blockers) reduce mortality and rec urrent myocardial infarction (MI) in older patients after both Q-wave MI and non-Q-wave MI. The effects of beta-blockers are to: (i) reduce complex ventricular arrhythmias, including ventricular tachycardia; (i i) increase the ventricular fibrillation threshold; (iii) reduce myoca rdial ischaemia; (iv) decrease sympathetic tone; (v) markedly attenuat e the circadian variation of complex ventricular arrhythmias; (vi) abo lish the circadian variation of myocardial ischaemia; and (vii) abolis h the circadian variation of sudden cardiac death or MI. beta-Blockers reduce mortality in patients with MI and complex ventricular arrhythm ias. In addition, they are excellent antianginal agents. Older persons with hypertension who have had an MI should be treated initially with a beta-blocker. beta-Blockers reduce mortality in patients with: (i) diabetes mellitus who have had an MI; (ii) MI and congestive heart fai lure with an abnormal or normal left ventricular ejection fraction; an d (iii) MI and an asymptomatic abnormal left ventricular ejection frac tion. Severe congestive heart failure, severe peripheral arterial dise ase with threatening gangrene, greater than first degree atrioventricu lar block, hypotension, bradycardia, lung disease with bronchospasm, a nd bronchial asthma are contraindications to treatment with beta-block ers.