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Beta blocker rebound phenomenon is important, but we do not know its definition, incidence or optimal prevention strategies

Hypertension Research volume 43, pages 591–596 (2020)Cite this article

Abstract

The aim of this review is to analyze whether there is a need for scientific information about the beta blocker (BB) rebound phenomenon; whether such information is available; and, if it is, how detailed is the BB rebound phenomenon explained in the guidelines and papers? A narrative review is used due to the lack of valid randomized clinical trials (RCTs) on the topic, which are needed for a meta-analysis. The BB rebound phenomenon can have dangerous consequences. The discontinuation of a BB leads to a fourfold increased risk of events related to coronary artery disease in hypertensive patients; it increases in-hospital mortality in heart failure patients; it can precipitate angina pectoris attack; and it increases the risk for death and rehospitalization in patients who survive acute myocardial infarction. Consequently, being considered in the guidelines, the BB rebound phenomenon is believed to be clinically relevant (by experts in the field). This is in sharp contrast with the lack of any additional relevant information about the BB rebound phenomenon in the various important guidelines. For example, we lack a consensus about the precise definition. Moreover, data about the incidence and optimal prevention strategies are lacking for the phenomenon (which is sometimes life-threatening). The BB rebound phenomenon is an additional reason why it is very important to test the prognosis of patients following the cessation of long-term medicaments in RCTs, particularly for BBs.

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Acknowledgements

This work has been supported by the Serbian Ministry of Education and Science, Belgrade, Serbia, grants No.175092 and No. III41018.

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Authors and Affiliations

  1. Department for Cardiovascular Diseases, Clinical Center Nis, Nis, Serbia

    Goran Koracevic, Tomislav Kostic & Miomir Randjelovic

  2. Faculty of Medicine, University of Nis, Nis, Serbia

    Goran Koracevic, Sladjana Micic, Tomislav Kostic, Radmila Velickovic Radovanovic, Dragan Djordjevic & Maja Koracevic

  3. Institute for Treatment and Rehabilitation Niska Banja, Nis, Serbia

    Milovan Stojanovic & Dragan Djordjevic

  4. Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia

    Miloje Tomasevic

  5. Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia

    Miloje Tomasevic

  6. Clinic for Internal Diseases Intermedica, Nis, Serbia

    Dragan Lovic

  7. Community Health Centre Dr Sava Stanojevic, Trstenik, Serbia

    Zaklina Ristic

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Correspondence to Milovan Stojanovic.

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Koracevic, G., Micic, S., Stojanovic, M. et al. Beta blocker rebound phenomenon is important, but we do not know its definition, incidence or optimal prevention strategies. Hypertens Res 43, 591–596 (2020). https://doi.org/10.1038/s41440-020-0449-6

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