title: Beta-blockers for preventing stroke recurrence.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  We searched the Cochrane Stroke Group Trials Register (May 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library 2014, Issue 5), the Database of Abstracts of Reviews of Effects (DARE) (May 2014), MEDLINE (1966 to May 2014), EMBASE (1980 to May 2014), and Latin American and Caribbean Health Sciences Literature (LILACS) (1982 to May 2014). We also searched ongoing trials registers and reference lists.
  
  
  METHODS
  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.
  
  
  METHODS
  Two review authors independently screened the trials identified, appraised quality, and extracted data.
  
  
  RESULTS
  We included two RCTs involving 2193 participants in the review. Both studies randomised participants to either beta-blocker (atenolol 5 mg) or placebo and were of a high methodological quality. We noted no statistical differences among the groups in risks of fatal and non-fatal stroke (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.76 to 1.18). For other outcomes analysed (major vascular events, death from all causes, death from cardiovascular causes) , we observed no significant differences between the groups. There were minor blood pressure reductions in the intervention group. Neither of the included studies reported the occurrence of diabetes among their outcomes or assessed quality of life. Adverse events were significantly more frequent in participants taking atenolol than in those given placebo, and were the most common reason given for discontinuing treatment (RR 1.85, 95% CI 1.45 to 2.35).
  
  
  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.
authors.affiliation: Brazilian Cochrane Centre, Universidade Federal de São Paulo, Rua Pedro de Toledo 598, São Paulo, São Paulo, Brazil, 04039-001.
authors.forename: Luiz Gustavo
authors.initials: LG
authors.lastname: De Lima
authors.forename: Humberto
authors.initials: H
authors.lastname: Saconato
authors.forename: Alvaro N
authors.initials: AN
authors.lastname: Atallah
authors.forename: Edina M K
authors.initials: EM
authors.lastname: da Silva
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control*
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D001262:Atenolol