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. There were lower rates of recurrent MI and VF in the treated group, outcomes that were balanced by a significantly higher rate of cardiogenic shock with metoprolol, especially on days 0 and 1. The like- lihood of developing cardiogenic shock was increased in certain subgroups, including patients with age >70 years, Table 12. 