New evidence from five randomized trials suggests that withholding β-blockers after myocardial infarction (MI) is safe for carefully selected, low-risk patients. However, even if β-blockers are not required to treat ventricular dysfunction, hypertension or arrhythmias, it might still be wiser to continue treatment during the vulnerable period immediately after MI and withdraw treatment several months later.
This is a preview of subscription content, access via your institution
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$32.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 print issues and online access
$189.00 per year
only $15.75 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Rao, S. V. et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J. Am. Coll. Cardiol. 85, 2135–2237 (2025).
Byrne, R. A. et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur. Heart J. 44, 3720–3826 (2023).
Yndigegn, T. et al. Beta-blockers after myocardial infarction and preserved ejection fraction. N. Engl. J. Med. 390, 1372–1381 (2024).
Ibanez, B. et al. Beta-blockers after myocardial infarction without reduced ejection fraction. N. Engl. J. Med. https://doi.org/10.1056/NEJMoa2504735 (2025).
Munkhaugen, J. et al. Beta-blockers after myocardial infarction in patients without heart failure. N. Engl. J. Med. https://doi.org/10.1056/NEJMoa2505985 (2025).
Silvain, J. et al. Beta-blocker interruption or continuation after myocardial infarction. N. Engl. J. Med. 391, 1277–1286 (2024).
Rossello, X. et al. β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysis of randomised controlled trials. Lancet 406, 1128–1137 (2025).
Rossello, X. et al. Beta-blockers after myocardial infarction: effects according to sex in the REBOOT trial. Eur. Heart J. https://doi.org/10.1093/eurheartj/ehaf673 (2025).
Hall, M. et al. Health outcomes after myocardial infarction: a population study of 56 million people in England. PLoS Med. 21, e1004343 (2024).
Freemantle, N., Cleland, J., Young, P., Mason, J. & Harrison, J. Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 318, 1730–1737 (1999).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
J.G.F.C. has received research grants and honoraria for advisory boards from Bayer and for advisory boards, steering committee and lectures from Pharmacosmos.
Rights and permissions
About this article
Cite this article
Cleland, J.G.F. Safely implementing new knowledge from trials of withholding β-blockers after myocardial infarction. Nat Rev Cardiol 22, 915–916 (2025). https://doi.org/10.1038/s41569-025-01228-w
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41569-025-01228-w