Clinical trials have documented that beta-blockers signifi¬cantly prevent death in patients who are given the drug from the first week of the heart attack and for an additional two years.
A. Norwegian Postinfarction Timolol Trial
This hallmark clinical trial was the first to document the life-saving effects of beta-blockers in patients following a heart attack (see Fig. 2). In this superbly well-conducted Norwegian study, 1884 patients were randomized to two groups. The first group of 942 patients was started on a beta-blocker, timolol, 7 days after a heart attack. The other group received a placebo. At the end of two years, the treated group had a 35% reduction in heart death, 28% reduction in new heart attack, and 67% reduction in sudden death ( p < 0.001). The impressive results were observed in smokers and nonsmokers; they were published in 1981 (see Fig. 2).
B. The American Beta-Blocker Heart Attack Trial
The Beta-Blocker Heart Attack Trial (BHAT) gave simi¬lar if not just as impressive results. In 16,400 random¬ized patients, propranolol, 120–240 mg, administered to patients 14 days after myocardial infarction and fol¬lowed for 2 years showed a significant 26% reduction in mortality rate. Propranolol was not effective in smokers, however, because of the interactions in the liver; cigarette smoking lowers the blood levels of propranolol and decreases cardioprotective effects.

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