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

Abstract

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.

Detection of airway protective level of the cough reflex in acute stroke patients

“…Also, stroke location either anterior or posterior circulation, type, past medical history, and medications did not show a significant difference between patients with and without post-stroke chest infection. All our stroke patients had a significantly higher cough threshold level (1.08 mol/L) than the normal value (0.8 mol/L); this is consistent with the results of [14] who studied the cough reflex in post-stroke patients and found that its mean values were higher than the values of the healthy volunteers, in common we both found that stroke patients needed higher citric acid concentrations than healthy individuals.…”

Augmented β2-adrenergic signaling dampens the neuroinflammatory response following ischemic stroke and increases stroke size

“…There is a growing interest in understanding the impact of drugs targeting the sympathetic nervous system on stroke outcomes. Analyses of clinical stroke populations report that more than 50% of patients had prolonged use of β-blockers prior to experiencing stroke, some of which act on the β2-receptor [35, 36]. Also, after stroke, patients may receive therapy with pressors to increase their blood pressure, and some act on the β2-receptor (e.g., norepinephrine and epinephrine), while others do not (e.g., neosynephrine) [6].…”

Pre-Stroke Antihypertensive Therapy Affects Stroke Severity and 3-Month Outcome of Ischemic MCA-Territory Stroke

“…Contrary to the findings of Renner et al [ 6 ], Tziomalos et al [ 5 ] reported that the patients with pre-stroke use of diuretics had a median admission NIHSS of 2 while all other antihypertensive drug classes including BBs were without effect on the initial median NIHSS of 12. The use of BBs and/or diuretics may on the other hand hint towards severe cardiac diseases, which are associated with a more severe acute stroke severity [ 7 , 20 ]. Overall, in our cohort of slightly to moderately handicapped acute stroke patients, the effect of BBs and diuretics on stroke severity is small compared to the relevance of penumbra and infarct core size on initial CTP.…”

“…Overall, however, the literature on pre-stroke antihypertensive medication and stroke severity and outcome is sparse and cannot really contribute to the question of which drug class could be recommended as the first-line therapy in patients with HBP. Pre-stroke use of diuretics [ 5 , 6 ] has been reported to have a beneficial but also a worsening effect on stroke severity and outcome; BBs [ 7 ] may not lead to a worse outcome compared to other antihypertensive medications, and ACEIs [ 8 , 9 ] may or may not be associated with a reduction in stroke severity and stroke ischemia volume. CA assessment is a routine procedure in our stroke unit using the bedside method of dynamic cerebral autoregulation (dCA).…”