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Time of Day

Fig. 14. The morning increase in infarctions seen in the ISAM trial (C) was preserved in patients taking calcium channel blocking agents (B) but was attenuated in patients taking b-blocking drugs (A). Reprinted with permission from ref. 25.

Time of Day

Fig. 14. The morning increase in infarctions seen in the ISAM trial (C) was preserved in patients taking calcium channel blocking agents (B) but was attenuated in patients taking b-blocking drugs (A). Reprinted with permission from ref. 25.

agents at the time of the acute event (24,25,27,35,69,159) (Fig. 14). b-Blocking agents also have been shown to reduce the morning increase in frequency of ventricular tachyarrhythmias in patients with AICDs (160) and to attenuate the morning increase in sudden cardiac deaths in postmyocardial infarction patients (161). Studies of unstable angina and non-Q wave myocardial infarction have not demonstrated this beneficial effect of (3-blockade on the circadian variation of these events (37,41). However, this finding is still consistent with a beneficial effect of b-blockers on triggering mechanisms, in that it may represent a b-blocker therapy-related shift in morning events from acute myocardial infarction to less serious acute ischemic syndromes (37). Several randomized prospective studies of b-blocker therapy in patients with ambulatory ischemia have also shown a beneficial effect of these drugs on the frequency of acute ischemic events (162,163).

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