Key result
Beta-blocker use was an independent predictor of less severe stroke on presentation.
Why the study?
Does beta-blocker treatment reduce stroke severity on presentation in patients with stroke?
Cohort (n=111)
Does beta-blocker treatment reduce stroke severity on presentation in patients with stroke?
Beta-blocker use prior to stroke is associated with less severe neurological deficits on presentation, potentially mediated by reduced sympathetic tone, inflammation, and coagulation.
Answers are grounded in this paper and cite their sources.
Beta-blocker use may link to milder stroke presentation; hypothesis-generating and requires randomized confirmation before practice change.
OBJECTIVE: Because activated sympathetic tone is associated with poorer outcome after stroke, we investigated whether beta-blocker treatment was associated with lesser stroke severity and improved outcome. METHOD: We prospectively studied 111 patients with stroke. Stroke severity on presentation gauged by Canadian Neurologic Scale (CanNS) and medication use verified from medical records. Power spectral analysis of heart rate variability estimated cardiac sympathovagal tone. Coagulation and inflammatory activity were assessed. RESULTS: On multiple linear regression, beta-blocker use was the sole independent predictor of less severe stroke on presentation (95% CI: 0.12 to 1.86: p = 0.03). When CanNS was dichotomized, multiple logistic regression revealed that beta-blocker use (odds ratio [OR] 3.70, 95% CI: 1.24 to 11.01, p = 0.02) and female gender (OR 2.96, 95% CI: 1.14 to 7.69, p = 0.03) were independent predictors of CanNS score >8.5. There was no difference in blood pressure and blood glucose between these two groups. Beta-blocker treatment was associated with lower sympathovagal tone (p = 0.001), thrombin (p = 0.009), hemoglobin A(1)C levels (p = 0.02), and erythrocyte sedimentation rate (p = 0.003). CONCLUSION: Beta-blocker use is associated with less severe stroke on presentation and may be cerebroprotective due to a sympatholytic effect associated with decreased thrombin, inflammation, and hemoglobin A(1)C.
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Laowattana et al. (2007) conducted a cohort in Stroke (n=111). Beta-blocker use vs. No beta-blocker use was evaluated on Less severe stroke on presentation (Canadian Neurologic Scale score >8.5) (OR 3.70, 95% CI 1.24-11.01, p=0.02). Beta-blocker use was an independent predictor of less severe stroke on presentation.
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