β-Blockers, pneumonia, and outcome after ischemic stroke
Background and Purpose—Increased sympathetic drive after stroke is involved in the pathophysiology of several complications including poststroke immunudepression. β-Blocker (BB) therapy has been suggested to have neuroprotective properties and to decrease infectious complications after stroke. We ai...
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| Main Authors: | , |
|---|---|
| Format: | Article (Journal) |
| Language: | English |
| Published: |
21 Apr 2015
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| In: |
Stroke
Year: 2015, Volume: 46, Issue: 5, Pages: 1269-1274 |
| ISSN: | 1524-4628 |
| DOI: | 10.1161/STROKEAHA.114.008260 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1161/STROKEAHA.114.008260 Verlag, lizenzpflichtig, Volltext: https://www.ahajournals.org/doi/10.1161/STROKEAHA.114.008260 
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| Author Notes: | Marek Sykora, Pavel Siarnik, Jennifer Diedler, K.R. Lees, A. Alexandrov, P.M. Bath, E. Bluhmki, N. Bornstein, L. Claesson, S.M. Davis, G. Donnan, H. C. Diener, M. Fisher, M. Ginsberg, B. Gregson, J. Grotta, W. Hacke, M.G. Hennerici, M. Hommel, M. Kaste, P. Lyden, J. Marler, K. Muir, R. Sacco, A. Shuaib, P. Teal, N.G. Wahlgren, S. Warach, and C. Weimar |
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| 520 | |a Background and Purpose—Increased sympathetic drive after stroke is involved in the pathophysiology of several complications including poststroke immunudepression. β-Blocker (BB) therapy has been suggested to have neuroprotective properties and to decrease infectious complications after stroke. We aimed to examine the effects of random pre- and on-stroke BB exposure on mortality, functional outcome, and occurrence of pneumonia after ischemic stroke.Methods—Data including standard demographic and clinical variables as well as prestroke and on-stroke antihypertensive medication, incidence of pneumonia, functional outcome defined using modified Rankin Scale and mortality at 3 months were extracted from the Virtual International Stroke Trials Archive. For statistical analysis multivariable Poisson regression was used.Results—In total, 5212 patients were analyzed. A total of 1155 (22.2%) patients were treated with BB before stroke onset and 244 (4.7%) patients were newly started with BB in the acute phase of stroke. Mortality was 17.5%, favorable outcome (defined as modified Rankin Scale, 0-2) occurred in 58.2% and pneumonia in 8.2% of patients. Prestroke BB showed no association with mortality. On-stroke BB was associated with reduced mortality (adjusted risk ratio, 0.63; 95% confidence interval, 0.42-0.96). Neither prestroke BB nor on-stroke BB showed an association with functional outcome. Both prestroke and on-stroke BB were associated with reduced frequency of pneumonia (adjusted risk ratio, 0.77; 95% confidence interval, 0.6-0.98 and risk ratio, 0.49; 95% confidence interval, 0.25-0.95).Conclusions—In this large nonrandomized comparison, on-stroke BB was associated with reduced mortality. Prestroke and on-stroke BB were inversely associated with incidence of nosocomial pneumonia. Randomized trials investigating the potential of β-blockade in acute stroke may be warranted. | ||
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