The End of the Beta-Blocker Era in oHCM?
For more than 60 years, the pharmacological management of symptomatic obstructive hypertrophic cardiomyopathy (oHCM) has relied heavily on beta-blockers as first-line therapy. Despite this long-standing clinical tradition, the evidence supporting beta-blockers for improving exercise capacity or altering the disease course in oHCM has been surprisingly limited. The emergence of cardiac myosin inhibitors has fundamentally shifted the therapeutic paradigm, moving away from non-specific negative inotropy and toward targeted molecular intervention. The MAPLE-HCM trial, a Phase 3 head-to-head comparison, marks a pivotal moment in this evolution, positioning aficamten not just as an alternative, but as a potentially superior primary treatment option over metoprolol.
