Protective effects of beta-blockers in cerebrovascular disease.
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.


METHODS
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).


CONCLUSIONS
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.
Laowattana
Somchai
S
Baylor College of Medicine, Houston, TX, USA.
Oppenheimer
Stephen M
SM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001799:Blood Sedimentation; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D011379:Prognosis; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology; D013917:Thrombin / Q000378:metabolism; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists; D006442:Glycated Hemoglobin; D018696:Neuroprotective Agents; D013917:Thrombin