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Beta blockers and hypertrophic obstructive cardiomyopathy : a systematic review and meta-analysis
Smith, Alexander Cromie, Amy Bowles, Libby Anderson, Thomas Panchal, Jay Walters, Ben
Smith, Alexander
Cromie, Amy
Bowles, Libby
Anderson, Thomas
Panchal, Jay
Walters, Ben
Affiliation
University Hospitals Coventry and Warwickshire NHS Trust; George Eliot Hospital NHS Trust, Nuneaton; Chesterfield Royal Hospital NHS Foundation Trust; Kettering General Hospital NHS Foundation Trust; Doncaster and Bassetlaw Hospitals NHS Foundation Trust
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Publication date
2025-10-23
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Abstract
Background: Since the 1960s, beta blockers have been used to treat hypertrophic obstructive cardiomyopathy (HOCM), a genetic disorder causing abnormal heart muscle thickening. This systematic review evaluates their efficacy across clinical outcomes.
Methods: Registered on PROSPERO (CRD42022344255), searches were performed in June 2022 and updated in September 2025 across MEDLINE, Embase, CINAHL and PubMed. Two reviewers independently screened studies. Meta-analysis was undertaken when ≥3 comparable datasets were available; otherwise, narrative synthesis was used.
Results: 21 studies including 775 adults met inclusion criteria. Beta blockers significantly reduced left ventricular outflow tract (LVOT) gradient (Standardised mean difference (SMD) -1.57; 95% CI -2.07 to -1.07) and heart rate (SMD -1.19; 95% CI -2.24 to -0.14). Sensitivity analyses confirmed the robustness of the LVOT effect, while heart rate effects remained heterogeneous. Improvements in New York Heart Association class, exercise tolerance and symptom burden were consistently reported, although data were subjective and small in scale. Mortality evidence was limited to two retrospective cohorts with divergent findings.
Conclusions: Beta blockers provide consistent haemodynamic and symptomatic benefits in HOCM, but most evidence derives from small, older studies with high risk of bias and limited survival data. Contemporary, adequately powered randomised controlled trials are required to define optimal agent selection, dosing and long-term outcomes.
Citation
Smith AJ, Cromie AMM, Bowles L, Anderson T, Panchal J, Walters B. Beta blockers and hypertrophic obstructive cardiomyopathy: a systematic review and meta-analysis. Open Heart. 2025 Oct 23;12(2):e003460. doi: 10.1136/openhrt-2025-003460.
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Article
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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license.