Routine Medical Therapies See Table 12 for a summary of selected routine medical therapies. 8.1. Beta Blockers: Recommendations Class I 1. Oral beta blockers should be initiated in the first 24 hours in patients with STEMI who do not have any of the following: signs of HF, evidence of a low output state, increased risk for cardiogenic shock, or other contraindications to use of oral beta blockers (PR in- terval more than 0.24 seconds, second- or third-de- gree heart block, active asthma, or reactive airways (Level of Evidence: B) 2. Beta blockers should be continued during and af- ter hospitalization for all patients with STEMI and with no contraindications to their use.417,418 (Level of Evidence: B) Risk factors for cardiogenic shock (the greater the number of risk factors present, the higher the risk of developing cardiogenic shock) are age >70 years, systolic BP <120 mm Hg, sinus tachycardia >110 bpm or heart rate <60 bpm, and increased time since onset of symptoms of STEMI. O Gara et al 2013 ACCF/AHA STEMI Guideline e389 3. Patients with initial contraindications to the use of beta blockers in the first 24 hours after STEMI should be reevaluated to determine their subsequent eligibility. (Level of Evidence: C) Class IIa 1. It is reasonable to administer intravenous beta blockers at the time of presentation to patients with STEMI and no contraindications to their use who are hypertensive or have ongoing ischemia.414 416 (Level of Evidence: B) The efficacy and safety of the early routine use of intravenous beta blockers were examined in COMMIT/CCS-2 (Clopi- dogrel and Metoprolol in Myocardial Infarction Trial).414 Early intravenous metoprolol followed by high-dose oral therapy had a neutral effect on the combined endpoint of death, recurrent MI, or cardiac arrest. 