Silvia Koton1, David Tanne, Ehud Grossman. 1. aStanley Steyer School of Health Professions, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University bNeurology Department and Joseph Sagol Neuroscience Center cInternal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
BACKGROUND: Beta-blockers are not recommended as the initial therapy for hypertension. Reports on associations between use of beta-blockers and stroke severity are inconclusive. We assessed associations between prestroke use of beta-blockers and stroke severity, poststroke disability and death in a large group of hypertensive patients hospitalized with acute ischemic stroke. METHODS: All 3915 patients with ischemic stroke, treated prestroke for hypertension and registered in the National Acute Stroke ISraeli, were included. Treatment for hypertension was classified by medication type (beta-blockers, diuretics, calcium antagonists and renin-angiotensin system blockers). Odds ratios for stroke severity by the National Institutes of Health Stroke Scale score, disability or death at discharge (modified Rankin Score ≥2) and 1-month mortality were calculated for patients treated vs. nontreated with beta-blockers, adjusted for admission SBP and additional risk factors. RESULTS: Use of beta-blockers was reported for 2043 (52%) participants. Mean (SD) admission SBP was lower in patients treated than nontreated with beta-blockers [156.7 (28.4) vs. 159.9 (27.8) mmHg; P = 0.0005]. Patients on combination therapy including beta-blockers used more antihypertensive medications than patients on combination therapy not including beta-blockers [mean (SD) = 2.63 (0.70) vs. mean (SD) = 2.17 (0.40); P < 0.0001]. Adjusted odds ratios (95% confidence intervals) for outcomes for beta-blocker users compared with nonusers were 1.09 (0.90-1.32) for severe stroke, 0.87 (0.73-1.03) for disability or death at discharge and 0.99 (0.74-1.31) for 1-month mortality. Findings were similar for patients on monotherapy. CONCLUSION: Prestroke use of beta-blockers in hypertensive patients with acute ischemic stroke was not associated with stroke severity, functional outcome or death.
BACKGROUND: Beta-blockers are not recommended as the initial therapy for hypertension. Reports on associations between use of beta-blockers and stroke severity are inconclusive. We assessed associations between prestroke use of beta-blockers and stroke severity, poststroke disability and death in a large group of hypertensivepatients hospitalized with acute ischemic stroke. METHODS: All 3915 patients with ischemic stroke, treated prestroke for hypertension and registered in the National Acute Stroke ISraeli, were included. Treatment for hypertension was classified by medication type (beta-blockers, diuretics, calcium antagonists and renin-angiotensin system blockers). Odds ratios for stroke severity by the National Institutes of Health Stroke Scale score, disability or death at discharge (modified Rankin Score ≥2) and 1-month mortality were calculated for patients treated vs. nontreated with beta-blockers, adjusted for admission SBP and additional risk factors. RESULTS: Use of beta-blockers was reported for 2043 (52%) participants. Mean (SD) admission SBP was lower in patients treated than nontreated with beta-blockers [156.7 (28.4) vs. 159.9 (27.8) mmHg; P = 0.0005]. Patients on combination therapy including beta-blockers used more antihypertensive medications than patients on combination therapy not including beta-blockers [mean (SD) = 2.63 (0.70) vs. mean (SD) = 2.17 (0.40); P < 0.0001]. Adjusted odds ratios (95% confidence intervals) for outcomes for beta-blocker users compared with nonusers were 1.09 (0.90-1.32) for severe stroke, 0.87 (0.73-1.03) for disability or death at discharge and 0.99 (0.74-1.31) for 1-month mortality. Findings were similar for patients on monotherapy. CONCLUSION: Prestroke use of beta-blockers in hypertensivepatients with acute ischemic stroke was not associated with stroke severity, functional outcome or death.