Prestroke treatment with beta-blockers for hypertension is not associated with severity and poor outcome in patients with ischemic stroke: data from a national stroke registry

Silvia Koton, David Tanne, Ehud Grossman

Research output: Contribution to journalArticle

Abstract

BACKGROUND:: Beta-blockers are not recommended as the initial therapy for hypertension. Reports on associations between use of beta-blockers and stroke severity are inconclusive. We assessed associations between prestroke use of beta-blockers and stroke severity, poststroke disability and death in a large group of hypertensive patients hospitalized with acute ischemic stroke. METHODS:: All 3915 patients with ischemic stroke, treated prestroke for hypertension and registered in the National Acute Stroke ISraeli, were included. Treatment for hypertension was classified by medication type (beta-blockers, diuretics, calcium antagonists and renin–angiotensin system blockers). Odds ratios for stroke severity by the National Institutes of Health Stroke Scale score, disability or death at discharge (modified Rankin Score ≥2) and 1-month mortality were calculated for patients treated vs. nontreated with beta-blockers, adjusted for admission SBP and additional risk factors. RESULTS:: Use of beta-blockers was reported for 2043 (52%) participants. Mean (SD) admission SBP was lower in patients treated than nontreated with beta-blockers [156.7 (28.4) vs. 159.9 (27.8)?mmHg; P?=?0.0005]. Patients on combination therapy including beta-blockers used more antihypertensive medications than patients on combination therapy not including beta-blockers [mean (SD)?=?2.63 (0.70) vs. mean (SD)?=?2.17 (0.40); P?<?0.0001]. Adjusted odds ratios (95% confidence intervals) for outcomes for beta-blocker users compared with nonusers were 1.09 (0.90–1.32) for severe stroke, 0.87 (0.73–1.03) for disability or death at discharge and 0.99 (0.74–1.31) for 1-month mortality. Findings were similar for patients on monotherapy. CONCLUSION:: Prestroke use of beta-blockers in hypertensive patients with acute ischemic stroke was not associated with stroke severity, functional outcome or death.

Original languageEnglish (US)
JournalJournal of Hypertension
DOIs
StateAccepted/In press - Dec 24 2016
Externally publishedYes

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Registries
Stroke
Hypertension
Therapeutics
Odds Ratio
Mortality
National Institutes of Health (U.S.)
Diuretics
Antihypertensive Agents
Confidence Intervals
Calcium

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

@article{68257be77dec49188459a637b6d9299c,
title = "Prestroke treatment with beta-blockers for hypertension is not associated with severity and poor outcome in patients with ischemic stroke: data from a national stroke registry",
abstract = "BACKGROUND:: Beta-blockers are not recommended as the initial therapy for hypertension. Reports on associations between use of beta-blockers and stroke severity are inconclusive. We assessed associations between prestroke use of beta-blockers and stroke severity, poststroke disability and death in a large group of hypertensive patients hospitalized with acute ischemic stroke. METHODS:: All 3915 patients with ischemic stroke, treated prestroke for hypertension and registered in the National Acute Stroke ISraeli, were included. Treatment for hypertension was classified by medication type (beta-blockers, diuretics, calcium antagonists and renin–angiotensin system blockers). Odds ratios for stroke severity by the National Institutes of Health Stroke Scale score, disability or death at discharge (modified Rankin Score ≥2) and 1-month mortality were calculated for patients treated vs. nontreated with beta-blockers, adjusted for admission SBP and additional risk factors. RESULTS:: Use of beta-blockers was reported for 2043 (52{\%}) participants. Mean (SD) admission SBP was lower in patients treated than nontreated with beta-blockers [156.7 (28.4) vs. 159.9 (27.8)?mmHg; P?=?0.0005]. Patients on combination therapy including beta-blockers used more antihypertensive medications than patients on combination therapy not including beta-blockers [mean (SD)?=?2.63 (0.70) vs. mean (SD)?=?2.17 (0.40); P?<?0.0001]. Adjusted odds ratios (95{\%} confidence intervals) for outcomes for beta-blocker users compared with nonusers were 1.09 (0.90–1.32) for severe stroke, 0.87 (0.73–1.03) for disability or death at discharge and 0.99 (0.74–1.31) for 1-month mortality. Findings were similar for patients on monotherapy. CONCLUSION:: Prestroke use of beta-blockers in hypertensive patients with acute ischemic stroke was not associated with stroke severity, functional outcome or death.",
author = "Silvia Koton and David Tanne and Ehud Grossman",
year = "2016",
month = "12",
day = "24",
doi = "10.1097/HJH.0000000000001218",
language = "English (US)",
journal = "Journal of Hypertension",
issn = "0263-6352",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Prestroke treatment with beta-blockers for hypertension is not associated with severity and poor outcome in patients with ischemic stroke

T2 - data from a national stroke registry

AU - Koton, Silvia

AU - Tanne, David

AU - Grossman, Ehud

PY - 2016/12/24

Y1 - 2016/12/24

N2 - BACKGROUND:: Beta-blockers are not recommended as the initial therapy for hypertension. Reports on associations between use of beta-blockers and stroke severity are inconclusive. We assessed associations between prestroke use of beta-blockers and stroke severity, poststroke disability and death in a large group of hypertensive patients hospitalized with acute ischemic stroke. METHODS:: All 3915 patients with ischemic stroke, treated prestroke for hypertension and registered in the National Acute Stroke ISraeli, were included. Treatment for hypertension was classified by medication type (beta-blockers, diuretics, calcium antagonists and renin–angiotensin system blockers). Odds ratios for stroke severity by the National Institutes of Health Stroke Scale score, disability or death at discharge (modified Rankin Score ≥2) and 1-month mortality were calculated for patients treated vs. nontreated with beta-blockers, adjusted for admission SBP and additional risk factors. RESULTS:: Use of beta-blockers was reported for 2043 (52%) participants. Mean (SD) admission SBP was lower in patients treated than nontreated with beta-blockers [156.7 (28.4) vs. 159.9 (27.8)?mmHg; P?=?0.0005]. Patients on combination therapy including beta-blockers used more antihypertensive medications than patients on combination therapy not including beta-blockers [mean (SD)?=?2.63 (0.70) vs. mean (SD)?=?2.17 (0.40); P?<?0.0001]. Adjusted odds ratios (95% confidence intervals) for outcomes for beta-blocker users compared with nonusers were 1.09 (0.90–1.32) for severe stroke, 0.87 (0.73–1.03) for disability or death at discharge and 0.99 (0.74–1.31) for 1-month mortality. Findings were similar for patients on monotherapy. CONCLUSION:: Prestroke use of beta-blockers in hypertensive patients with acute ischemic stroke was not associated with stroke severity, functional outcome or death.

AB - BACKGROUND:: Beta-blockers are not recommended as the initial therapy for hypertension. Reports on associations between use of beta-blockers and stroke severity are inconclusive. We assessed associations between prestroke use of beta-blockers and stroke severity, poststroke disability and death in a large group of hypertensive patients hospitalized with acute ischemic stroke. METHODS:: All 3915 patients with ischemic stroke, treated prestroke for hypertension and registered in the National Acute Stroke ISraeli, were included. Treatment for hypertension was classified by medication type (beta-blockers, diuretics, calcium antagonists and renin–angiotensin system blockers). Odds ratios for stroke severity by the National Institutes of Health Stroke Scale score, disability or death at discharge (modified Rankin Score ≥2) and 1-month mortality were calculated for patients treated vs. nontreated with beta-blockers, adjusted for admission SBP and additional risk factors. RESULTS:: Use of beta-blockers was reported for 2043 (52%) participants. Mean (SD) admission SBP was lower in patients treated than nontreated with beta-blockers [156.7 (28.4) vs. 159.9 (27.8)?mmHg; P?=?0.0005]. Patients on combination therapy including beta-blockers used more antihypertensive medications than patients on combination therapy not including beta-blockers [mean (SD)?=?2.63 (0.70) vs. mean (SD)?=?2.17 (0.40); P?<?0.0001]. Adjusted odds ratios (95% confidence intervals) for outcomes for beta-blocker users compared with nonusers were 1.09 (0.90–1.32) for severe stroke, 0.87 (0.73–1.03) for disability or death at discharge and 0.99 (0.74–1.31) for 1-month mortality. Findings were similar for patients on monotherapy. CONCLUSION:: Prestroke use of beta-blockers in hypertensive patients with acute ischemic stroke was not associated with stroke severity, functional outcome or death.

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