Pre‐stroke use of beta‐blockers does not affect ischaemic stroke severity and outcome

Raedt, Sylvie De; Haentjens, Patrick; Smedt, Ann De; Brouns, Raf; Uyttenboogaart, Maarten; Luijckx, Gert Jan; Keyser, Jacques De

doi:10.1111/j.1468-1331.2011.03475.x

Cited by 26 publications

(25 citation statements)

References 30 publications

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“…Moreover, only a few studies have taken into consideration the IS mechanism in multivariable analyses [4,5,7,10,11], even though it is strongly associated with initial severity, and the prevalence of smoking varies considerably according to the mechanism. Of note, our findings indicating that lower severity was observed in patients with either lacunar IS or IS from other etiology (including patients with cervical artery dissection), and that higher severity was noted in those with cardioembolic IS are in accordance with the literature [6,9,11,19]. Our results were also adjusted for several vascular risk factors, which may also have an impact on severity and for which distribution also differs according to smoking status.…”

Section: Discussionsupporting

confidence: 81%

Smoking Status and Severity of Ischemic Stroke. A Population-Based Study

et al. 2013

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We aimed to investigate the impact of smoking status on clinical severity in patients with ischemic stroke event (IS). Patients were prospectively identified among residents of the city of Dijon, France (ca. 151,000 inhabitants), using a population-based registry, between 2006 and 2011. Demographic and clinical data were recorded. The initial clinical severity was quantified by the means of the National Institutes of Health Stroke Scale (NIHSS). Multivariable ordinal logistic regression was used to assess the effect of smoking status on severity. Among the 1,056 recorded patients with IS, data about smoking status were available for 973 (92.1%), of whom 658 (67.3%) were non-smokers, 187 (19.2%) were current smokers, and 128 (13.2%) were former smokers. Compared with non-smoking, former smoking was associated with less severe IS (OR 0.55; 95% CI 0.38-0.82, p = 0.003), whereas this association was not found for current smokers (OR 0.97; 95% CI 0.69-1.36, p = 0.856). Further work is needed to understand the underlying mechanisms of this finding.

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Section: Discussionsupporting

confidence: 81%

Smoking Status and Severity of Ischemic Stroke. A Population-Based Study

et al. 2013

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“…This is in line with a recent large secondary analysis performed with the pooled data from 2 neuroprotection trials including 1375 patients where this hypothesis has been tested and dismissed. 22 These data were not included in the VISTA archive. The data set of these 2 neuroprotective trials therefore does not overlap with the data set of the recent analysis.…”

Section: Discussionmentioning

confidence: 99%

β-Blockers, Pneumonia, and Outcome After Ischemic Stroke

Sýkora

Šiarnik

Diedler

et al. 2015

Stroke

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Background and Purpose-Increased sympathetic drive after stroke is involved in the pathophysiology of several complications including poststroke immunudepression. β-Blocker (BB) therapy has been suggested to have neuroprotective properties and to decrease infectious complications after stroke. We aimed to examine the effects of random pre-and onstroke BB exposure on mortality, functional outcome, and occurrence of pneumonia after ischemic stroke. Methods-Data including standard demographic and clinical variables as well as prestroke and on-stroke antihypertensive medication, incidence of pneumonia, functional outcome defined using modified Rankin Scale and mortality at 3 months were extracted from the Virtual International Stroke Trials Archive. For statistical analysis multivariable Poisson regression was used. Results-In total, 5212 patients were analyzed. A total of 1155 (22.2%) patients were treated with BB before stroke onset and 244 (4.7%) patients were newly started with BB in the acute phase of stroke. Mortality was 17.5%, favorable outcome (defined as modified Rankin Scale, 0-2) occurred in 58.2% and pneumonia in 8.2% of patients. Prestroke BB showed no association with mortality. On-stroke BB was associated with reduced mortality (adjusted risk ratio, 0.63; 95% confidence interval, 0.42-0.96). Neither prestroke BB nor on-stroke BB showed an association with functional outcome. Both prestroke and on-stroke BB were associated with reduced frequency of pneumonia (adjusted risk ratio, 0.77; 95% confidence interval, 0.6-0.98 and risk ratio, 0.49; 95% confidence interval, 0.25-0.95). Conclusions-In this large nonrandomized comparison, on-stroke BB was associated with reduced mortality. Prestroke and on-stroke BB were inversely associated with incidence of nosocomial pneumonia. Randomized trials investigating the potential of β-blockade in acute stroke may be warranted.

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“…Several studies have shown that pre-and on-stroke use of BB was associated with less severe stroke 4 and reduced mortality, 5-7 but results have been inconsistent. [8][9][10][11][12][13] In 2006, the National Institute for Health and Care Excellence (NICE) removed BBs from its first-line antihypertensive regimens 14 and the Eighth Joint National Committee (JNC 8) reaffirmed this approach in 2014. 15 Still, many patients are prescribed BB as an antihypertensive medication, either as monotherapy, as part of a multi drug combination, or for concomitant indications.…”

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confidence: 99%

Pre admission treatment with Beta‐blockers in hypertensive patients with acute stroke and 3‐month outcome—Data from a national stroke registry

Eizenberg

Grossman

Tanné

et al. 2018

J of Clinical Hypertension

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Cerebrovascular disease is a leading cause of morbidity and mortality worldwide, 1 with hypertension being its most important modifiable risk factor. Landmark studies have shown that lowering blood pressure decreased rates of stroke incidence and mortality. 2 However, not all anti-hypertensive agents were found to be equally effective in preventing stroke. Comparative studies and meta-analyses have demonstrated that beta-blockers (BB) provide less protection against stroke compared with other anti-hypertensive agents. 3 On the other hand, stroke is associated with dysregulation of the autonomous nervous system with subsequent derangements of the cardiovascular, endocrine, and immune systems. Several studies have shown that pre-and on-stroke use of BB was associated with less severe stroke 4 and reduced mortality, 5-7 but results have been inconsistent. [8][9][10][11][12][13] In 2006 published data on the effect of pre-stroke treatment with BB on ischemic stroke severity, disability or death at discharge, and 1 month mortality. 16 The present study is aimed at exploring the effect of prestroke treatment with BB on ischemic stroke and intracerebral hemorrhage (ICH) outcomes 3 months after stroke. | METHODS | Study setting and participantsThe National Acute Stroke Israeli Survey (NASIS) registry is an ongo- The impact of beta-blockers (BB) treatment on stroke outcome is unclear. We used data from a prospective national stroke registry to assess the associations between use of BB and poor outcome 3 months after stroke. Using the National Acute StrokeIsraeli (NASIS) registry, we identified 1126 patients with ischemic stroke and intracerebral hemorrhage with pre-stroke hypertension treatment, who were followed for 3-months. Functional outcome and mortality at 3-month were compared by use of BB, adjusting for demographics and clinical factors. Pre-stroke use of BB was reported by 615 (54.6%) patients. Users of BB showed higher rates of atrial fibrillation, heart disease, statin use, cancer, and severe stroke. Adjusted odds-ratios (ORs, 95% CI) for BB users compared with non-users 3 months after stroke were 0.86 (0.49-1.52) for mortality and 1.07 (0.76-1.50) for Barthel Index ≤60. In conclusion, treatment with BB is not associated with 3-month poor outcome in hypertensive patients.

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Pre‐stroke use of beta‐blockers does not affect ischaemic stroke severity and outcome

Abstract: Pre-stroke use of beta-blockers does not appear to influence stroke severity and functional outcome at 3 months.

Cited by 26 publications

References 30 publications

Smoking Status and Severity of Ischemic Stroke. A Population-Based Study

Smoking Status and Severity of Ischemic Stroke. A Population-Based Study

β-Blockers, Pneumonia, and Outcome After Ischemic Stroke

Pre admission treatment with Beta‐blockers in hypertensive patients with acute stroke and 3‐month outcome—Data from a national stroke registry

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