Koton Silvia, Tanne David, Grossman Ehud
aStanley Steyer School of Health Professions, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University bNeurology Department and Joseph Sagol Neuroscience Center cInternal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Hypertens. 2017 Apr;35(4):870-876. doi: 10.1097/HJH.0000000000001218.
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.
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.
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.
Prestroke use of beta-blockers in hypertensive patients with acute ischemic stroke was not associated with stroke severity, functional outcome or death.
β受体阻滞剂不被推荐作为高血压的初始治疗药物。关于β受体阻滞剂的使用与中风严重程度之间关联的报道尚无定论。我们评估了一大组因急性缺血性中风住院的高血压患者中风前使用β受体阻滞剂与中风严重程度、中风后残疾及死亡之间的关联。
纳入了以色列国家急性中风登记处登记的、中风前接受高血压治疗的所有3915例缺血性中风患者。高血压治疗按药物类型（β受体阻滞剂、利尿剂、钙拮抗剂和肾素 - 血管紧张素系统阻滞剂）分类。计算接受与未接受β受体阻滞剂治疗的患者，根据美国国立卫生研究院中风量表评分得出的中风严重程度、出院时残疾或死亡（改良Rankin量表评分≥2）及1个月死亡率的比值比，并对入院收缩压和其他危险因素进行校正。
2043例（52%）参与者报告使用了β受体阻滞剂。接受β受体阻滞剂治疗的患者入院时平均（标准差）收缩压低于未接受治疗的患者[156.7（28.4）mmHg对159.9（27.8）mmHg；P = 0.0005]。接受包括β受体阻滞剂的联合治疗的患者比接受不包括β受体阻滞剂的联合治疗的患者使用更多的抗高血压药物[平均（标准差）= 2.63（0.70）对平均（标准差）= 2.17（0.40）；P < 0.0001]。与未使用者相比，β受体阻滞剂使用者结局的校正比值比（95%置信区间）为：严重中风为1.09（0.90 - 1.32），出院时残疾或死亡为0.87（0.73 - 1.03），1个月死亡率为0.99（0.74 - 1.31）。单药治疗患者的结果相似。
急性缺血性中风高血压患者中风前使用β受体阻滞剂与中风严重程度、功能结局或死亡无关。
