Effect of β-Adrenergic Antagonists on In-Hospital Mortality after Ischemic Stroke

Phelan, Christopher; Alaigh, Vivek; Fortunato, Gilbert; Staff, Ilene; Sansing, Lauren H

doi:10.1016/j.jstrokecerebrovasdis.2015.04.035

Cited by 16 publications

(11 citation statements)

References 37 publications

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“…In conclusion, we could not provide evidence for a protective effect of beta-blockers on post stroke infections and mortality. Data in humans remain inconclusive with studies showing protective effects on pneumonia rates [ 13 , 14 ] and mortality [ 29 ] while other studies show neutral effects [ 30 ] or increased rates of infections [ 16 ]. The latter may raise safety concerns of these commonly prescribed group of antihypertensive drugs.…”

Section: Discussionmentioning

confidence: 99%

Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression

et al. 2018

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BackgroundStroke-induced immunodepression is a well characterized complication of acute ischemic stroke. In experimental studies beta-blocker therapy reversed stroke-induced immunodepression, reduced infection rates and mortality. Recent, heterogeneous studies in stroke patients could not provide evidence of a protective effect of beta-blocker therapy. Aim of this study is to investigate the potential preventive effect of beta-blockers in subgroups of patients at high risk for stroke-induced immunodepression.MethodsData from a prospectively derived registry of major stroke patients receiving endovascular therapy between 2011–2017 in a tertiary stroke center (University Medical Center Göttingen. Germany) was used. The effect of beta-blocker therapy on pneumonia, urinary tract infection, sepsis and mortality was assessed using multivariate logistic regression analysis.ResultsThree hundred six patients with a mean age of 72 ± 13 years and a median NIHSS of 16 (IQR 10.75–20) were included. 158 patients (51.6%) had pre-stroke- and continued beta-blocker therapy. Beta-blocker therapy did not reduce the incidence of pneumonia (OR 0.78, 95% CI 0.31–1.92, p = 0.584), urinary tract infections (OR 1.51, 0.88–2.60, p = 0.135), sepsis (OR 0.57, 0.18–1.80, p = 0.334) or mortality (OR 0.59, 0.16–2.17, p = 0.429). Strokes involving the insula and anterio-medial cortex increased the risk for pneumonia (OR 4.55, 2.41–8.56, p<0.001) and sepsis (OR 4.13, 1.81–9.43, p = 0.001), while right hemispheric strokes increased the risk for pneumonia (OR 1.60, 0.92–2.77, p = 0.096). There was a non-significantly increased risk for urinary tract infections in patients with beta-blocker therapy and insula/anterio-medial cortex strokes (OR 3.12, 95% CI 0.88–11.05, p = 0.077) with no effect of beta-blocker therapy on pneumonia, sepsis or mortality in both subgroups.ConclusionsIn major ischemic stroke patients, beta-blocker therapy did not lower post-stroke infection rates and was associated with urinary tract infections in a subgroup with insula/anterio-medial strokes.

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Section: Discussionmentioning

confidence: 99%

Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression

et al. 2018

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“…From the specialists surveyed, seven cited either arterial hypertension or blood pressure on stroke admission as a risk factor for HT. Extremes values of blood pressure at admission may be a consequence of a severe neurological presentation 30 , meaning an adrenergic reaction, regardless of age and other underlying medical conditions. A recently published study 31 did not show differences in the risk of o HT or clinical outcomes of patients treated to lower blood pressure targets (Systolic Blood Pressure<140 mmHg) and standard therapy (Systolic Blood Pressure<180 mmHg) after treatment with intravenous thrombolysis.…”

Section: Discussionmentioning

confidence: 99%

Predictors of hemorrhagic transformation after acute ischemic stroke based on the experts’ opinion

Andrade

Mohr

Lima

et al. 2020

Arq. Neuro-Psiquiatr.

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Background: Hemorrhagic transformation (HT) is a common complication after ischemic stroke. It may be associated to poor outcomes. Some predictors of HT have been previously identified, but there remain controversies. Objective: To describe the risk factors for HT more frequently reported by a panel of experts surveyed for this project. Methods: We sent a standard questionnaire by e-mail to specialists in Vascular Neurology from 2014 to 2018. Forty-five specialists were contacted and 20 of them responded to the invitation. Predictors cited by three or more specialists were included in a table and ranked by the frequency in which they appeared. A review of the literature looking for published predictive scores of HT was performed, comparing to the answers received. Results: The 20 responding specialists cited 23 different risk factors for HT. The most frequent factors in the order of citation were the volume of ischemia, previous use of antithrombotic medication, neurological severity, age, hyperglycemia at presentation, hypertension on admission, and cardioembolism. Most variables were also found in previously published predictive scores, but they were reported by the authors with divergences of frequency. Conclusion: Although many studies have evaluated HT in patients with acute ischemic stroke, the published risk factors were neither uniform nor in agreement with those cited by the stroke specialists. These findings may be helpful to build a score that can be tested with the goal of improving the prediction of HT.

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“…These investigators found no effect on outcomes (stroke severity, recurrent stroke, or mortality) with the use of BB for pre-stroke hypertension therapy. Phelan and colleagues found a decrease in the in-hospital mortality in patients with AIS who had their home BB therapy continued during the first 3 days of AIS versus patients in whom BB therapy was discontinued [35]. This was despite a higher comorbid profile among patients on BB therapy [35].…”

Section: Discussionmentioning

confidence: 99%

“…Phelan and colleagues found a decrease in the in-hospital mortality in patients with AIS who had their home BB therapy continued during the first 3 days of AIS versus patients in whom BB therapy was discontinued [35]. This was despite a higher comorbid profile among patients on BB therapy [35]. Similarly, Tziomalos found worse in-hospital outcomes in patients treated with BB prior to AIS, than in those not treated with BB [36].…”

Section: Discussionmentioning

confidence: 99%

Interaction between Antihypertensive Therapy Class and Pulse Pressure on Outcomes Following Acute Ischemic Stroke

Lavelle¹,

Mathew²,

Arora³

et al. 2017

IJCM

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Goal: The effect of pulse pressure and interactions with type of antihypertensive therapy on mortality after acute ischemic stroke has not been previously evaluated. Materials and Methods: A retrospective cohort study was conducted to evaluate the independent and interactive effects of pulse pressure and antihypertensive class (specifically angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker, or beta blocker) on mortality following acute ischemic stroke. Findings/Conclusions: 343 patients were identified with 49 months of follow-up. Baseline pulse pressure was 64 mmHg and age was 66.5 years. Patients were divided at a pulse pressure of 70. Patients with pulse pressure ≥ 70 were older (p < 0.001) and had higher comorbid vascular burden (p = 0.031) than those with pulse pressure < 70. Pulse pressure did not remain a significant predictor of follow-up mortality after adjustment for baseline comorbidities. Angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker based therapy was associated with lower follow-up mortality when beta blocker was not used in pulse pressure < 70 group (odds ratio 0.07, 95% confidence interval 0.01 -0.48). Prospective analysis will be needed to confirm the protective effect of angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker based on pulse pressure in acute ischemic stroke.

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Effect of β-Adrenergic Antagonists on In-Hospital Mortality after Ischemic Stroke

Cited by 16 publications

References 37 publications

Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression

Influence of beta-blocker therapy on the risk of infections and death in patients at high risk for stroke induced immunodepression

Predictors of hemorrhagic transformation after acute ischemic stroke based on the experts’ opinion

Interaction between Antihypertensive Therapy Class and Pulse Pressure on Outcomes Following Acute Ischemic Stroke

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