Beta-adrenergic blockade after stroke. A preliminary closed cohort study.

To collect background data for a prospective clinical trial of beta-blocking agents in the prevention of deaths after stroke, the long-term prognosis in 60 patients discharged from a stroke unit on beta-blocker therapy was compared with the outcome in 60 matched patients with stroke but without beta-blockers. Matching included sex, age, type of stroke, and presence or absence of hypertension and cardiac failure. Thirteen patients (22%) in the beta-blocker group died during a median followup of 41 months. Of the 60 patients not on beta-blockade at discharge, 21 (35%) died during a median followup of 36 months. By life-table technique and log-rank test, the relative risk for death was 0.60:1.00 (p = 0.14). During followup, 12 recurrent strokes were observed in patients on beta-blockers and 19 in patients without beta-blockers (relative risk 0.57:1.00; p = 0.12). It appeared that the reduction in mortality could only marginally be ascribed to fewer deaths from myocardial infarction; other causes of death were also less frequent in beta-blocker-treated patients. The results emphasize that supplementary information on the effect of beta-blocking agents on mortality after stroke is needed before a larger trial of beta-blocker therapy in patients with manifest cerebrovascular disease can be initiated.