De Lima Luiz Gustavo, Soares Bernardo G O, Saconato Humberto, Atallah Alvaro N, da Silva Edina M K
Brazilian Cochrane Centre, Universidade Federal de São Paulo, São Paulo, Brazil.
Cochrane Database Syst Rev. 2013 May 31(5):CD007890. doi: 10.1002/14651858.CD007890.pub2.
Stroke affects 15 million people per year worldwide. Despite recent developments in acute stroke treatment, prevention remains very important. Stroke has a high rate of recurrence; therefore secondary prevention is also important. Many clinical approaches to control risk factors have been proposed. One of these approaches is the prescription of beta-blockers that have effects beyond the reduction of blood pressure, which can reduce the recurrence of stroke.
To evaluate the efficacy of beta-blockers for preventing stroke recurrence and for reducing death and major vascular events in people with a previous stroke or transient ischaemic attack (TIA), and to determine their safety, particularly with regard to the development of diabetes mellitus.
We searched the Cochrane Stroke Group Trials Register (December 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library 2011, Issue 12), the Database of Abstracts of Reviews of Effects (DARE) (December 2011), MEDLINE (1966 to December 2011), EMBASE (1980 to December 2011), and Latin American and Caribbean Health Sciences Literature (LILACS) (1982 to December 2011). We also searched ongoing trials registers and reference lists.
Randomised controlled trials (RCTs) that included participants with previous stroke or TIA due to arterial thrombosis or embolism.The intervention was any beta-blocker versus control, or beta-blocker plus other treatment versus other treatment.
Two review authors independently screened the trials identified, appraised quality, and extracted data.
We included two RCTs involving 2193 participants in the review. Both studies randomised participants to either beta-blocker (atenolol 5 mg) or placebo. No statistical differences were noted among the groups in risks of fatal and non-fatal stroke (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.75 to 1.17). For all other outcomes analysed (death from all causes, cardiac death, non-fatal myocardial infarction, major vascular events), we observed no significant differences between the groups.
AUTHORS' CONCLUSIONS: To date, no available evidence supports the routine use of beta-blockers for secondary prevention after stroke or TIA. More studies with larger samples are needed.
全球每年有1500万人罹患中风。尽管急性中风治疗方面最近有所进展，但预防仍然非常重要。中风复发率很高；因此二级预防也很重要。已经提出了许多控制危险因素的临床方法。其中一种方法是开具β受体阻滞剂，其作用不仅限于降低血压，还可降低中风复发率。
评估β受体阻滞剂对预防中风复发以及降低既往有中风或短暂性脑缺血发作（TIA）患者的死亡和重大血管事件的疗效，并确定其安全性，尤其是与糖尿病发生相关的安全性。
我们检索了Cochrane中风小组试验注册库（2011年12月）、Cochrane对照试验中央注册库（CENTRAL）和Cochrane系统评价数据库（CDSR）（《Cochrane图书馆》2011年第12期）、效果评价文摘数据库（DARE）（2011年12月）、医学文献数据库（MEDLINE，1966年至2011年12月）、荷兰医学文摘数据库（EMBASE，1980年至2011年12月）以及拉丁美洲和加勒比健康科学文献数据库（LILACS，1982年至2011年12月）。我们还检索了正在进行的试验注册库和参考文献列表。
随机对照试验（RCT），纳入既往因动脉血栓形成或栓塞而发生中风或TIA的参与者。干预措施为任何β受体阻滞剂与对照相比，或β受体阻滞剂加其他治疗与其他治疗相比。
两位综述作者独立筛选所识别的试验、评估质量并提取数据。
我们纳入了两项RCT，共2193名参与者。两项研究均将参与者随机分为β受体阻滞剂（阿替洛尔5毫克）组或安慰剂组。在致命和非致命中风风险方面，两组之间未发现统计学差异（风险比（RR）0.94，95%置信区间（CI）0.75至1.17）。对于分析的所有其他结局（全因死亡、心源性死亡、非致命性心肌梗死、重大血管事件），我们观察到两组之间无显著差异。
迄今为止，尚无证据支持中风或TIA后常规使用β受体阻滞剂进行二级预防。需要更多更大样本量的研究。
