Beta-blockers for hypertension

Wiysonge, Charles Shey; Bradley, Hazel; Volmink, Jimmy; Mayosi, Bongani M.; Opie, Lionel H.

doi:10.1002/14651858.cd002003.pub5

Cited by 244 publications

(134 citation statements)

References 153 publications

(320 reference statements)

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“…Beta‐blocker has been part of the antihypertension treatment arsenal for many years, but meta‐analyses have shown they are less effective than other agents in primary and secondary stroke prevention. Yet, BB may confer a benefit in stroke by mitigating the acute hyper activation of the sympathetic nervous system, which has been associated with adverse cardiovascular and immune effects …”

Section: Discussionmentioning

confidence: 99%

“…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 . On the other hand, stroke is associated with dysregulation of the autonomous nervous system with subsequent derangements of the cardiovascular, endocrine, and immune systems.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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“…However, modern hypertension trials have suggested that at similar attained blood pressure levels, beta‐blockers are actually less effective than angiotensin receptor blockers or calcium channel blockers, in terms of stroke prevention. The same picture has emerged from the most recent meta‐analysis on this topic, in which beta‐blocker use was associated with decreased risk for stroke compared with placebo, but beta‐blocker use was also associated with increased risk for stroke compared with renin angiotensin system inhibitors or calcium channel blockers. Several mechanisms have been proposed to explain this shortcoming of beta‐blockers: it has been suggested that beta‐blockers lower the central blood pressure to a lesser extent than the peripheral blood pressure, or that beta‐blockers lower the nocturnal blood pressure less effectively than other antihypertensive drugs .…”

mentioning

confidence: 68%

Beta‐blockers, hypertension, and stroke outcomes

Wijkman

2018

J of Clinical Hypertension

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“…Collectively, these data suggest Gly49 carriers may be less responsive to the antihypertensive effects of β-blockers, which is consistent with previous studies 19 . A recent Cochrane Review indicated that β-blockers have significantly reduced stroke risk compared to placebo, but have increased stroke risk when compared against calcium-channel blockers and renin-angiotensin system inhibitors 30 . Our data suggest this increased risk might be particularly important in Gly49 carriers treated with β-blockers.…”

Section: Discussionmentioning

confidence: 99%

Pharmacogenetic Associations of β1-Adrenergic Receptor Polymorphisms With Cardiovascular Outcomes in the SPS3 Trial (Secondary Prevention of Small Subcortical Strokes)

Magvanjav

McDonough

Gong

et al. 2017

Stroke

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Background and Purpose Functional polymorphisms (Ser49Gly and Arg389Gly) in ADRB1 have been associated with cardiovascular and β-blocker response outcomes. Herein we examined associations of these polymorphisms with Major Adverse Cardiovascular Events (MACE), with and without stratification by β-blocker treatment in patients with a history of stroke. Methods 926 participants of the Secondary Prevention of Small Subcortical Strokes (SPS3) trial’s genetic substudy with hypertension were included. MACE included stroke, myocardial infarction, and all-cause death. Kaplan-Meier and multivariable Cox regression analyses were used. Because the primary component of MACE was ischemic stroke, we tested the association of Ser49Gly with ischemic stroke among 41,475 individuals of European and African ancestry in the NINDS Stroke Genetics Network (SiGN). Results MACE was higher in carriers of the Gly49 allele than those with the Ser49Ser genotype (10.5% vs. 5.4%, log-rank p=0.005). Gly49 carrier status was associated with MACE (HR 1.62; 95% CI 1.00–2.68) and ischemic stroke (HR 1.81; 95% CI 1.01–3.23) in SPS3 and with small artery ischemic stroke (OR 1.14; 95% CI 1.03–1.26) in SiGN. In SPS3, β-blocker-treated Gly49 carriers had increased MACE versus non-β-blocker-treated individuals and non-carriers (HR 2.03; 95% CI 1.20–3.45). No associations were observed with the Arg389Gly polymorphism. Conclusion Among individuals with previous small artery ischemic stroke, the ADRB1 Gly49 polymorphism was associated with MACE, particularly small artery ischemic stroke, a risk that may be increased among β-blocker-treated individuals. Further research is needed to define β-blocker benefit among ischemic stroke patients by ADRB1 genotype. Clinical Trial Registration-URL http://www.clinicaltrials.gov. Unique identifier: NCT00059306.

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Beta-blockers for hypertension

Cited by 244 publications

References 153 publications

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

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

Beta‐blockers, hypertension, and stroke outcomes

Pharmacogenetic Associations of β1-Adrenergic Receptor Polymorphisms With Cardiovascular Outcomes in the SPS3 Trial (Secondary Prevention of Small Subcortical Strokes)

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