A substantial percentage of patients undergoing CABG receive preoperative -blocker therapy because it has been demonstrated to convey a mortality ben- Consequently, preoperative -blocker therapy was determined to be a quality metric for cardiac surgery by the National Quality Forum and was included in the Society of Thoracic Surgeons Composite Score for CABG Quality pro- However, other more recent studies have questioned whether preoperative -blocker therapy actually affects mor- It is possible that the outcomes from surgical revas- cularization have improved to the point where a benefit from preoperative -blocker therapy can no longer meet the thresh- old of statistical significance.204 Nevertheless, continuation of preoperative -blockade therapy into the postoperative period remains an important consideration. The use of -blocker therapy for the treatment of hyperten- sion remains a controversial subject. In a critical review of the literature, Bangalore et al205 documented that -blockade was not as effective long-term compared to other antihypertensive thera- pies (eg, diuretic therapy). In addition, -blockers are often asso- ciated with side effects such as weight gain, fatigue, and sexual dysfunction, reducing rates of adherence. Thus, for long-term secondary prevention therapy, the use of -blockers for hyperten- sion is influenced by the presence or absence of other cardiovas- cular conditions (such as previous MI and heart failure). The most compelling data on -blocker therapy exist after an acute MI, and this circumstance pertains to most post- CABG patients. Several studies from the 1980s and 1990s demonstrated the benefits associated with -blockade dur- ing and after MI.188,206 In a meta-analysis of >54000 patients, Freemantle et al207 reported a 23% reduction in the odds of death with -blocker therapy for long-term secondary preven- tion after MI. These studies and others laid the foundation for routine -blocker therapy after MI. 