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Abstract
Objectives: β-Blockers increase variability in systolic blood pressure (SBP), which probably explains their lesser effectiveness in preventing stroke vs myocardial infarction compared with other agents. This increase in variability in blood pressure (BP) may be particularly marked on non-cardioselective agents, potentially calling into question the widespread first-line use of propranolol in migraine with aura, elderly patients with essential tremor or anxiety, and other groups at risk of stroke.
Methods: We determined β-blocker subclass effects on variability in BP and stroke risk in a systematic review of randomized controlled trials (RCTs) comparing different types of β-blocker with placebo or other agents. We determined pooled estimates of the effect of treatment on group variability in BP (ratio of the variances [VR]) and on the risk of stroke vs myocardial infarction during follow-up.
Results: Compared with other antihypertensives, variability in SBP was increased more by nonselective β-blockers (VR=1.34, 1.13–1.59, p =0.002, 25 comparisons, 9,992 patients) than by β1-selective agents (VR=1.09, 95% confidence interval 1.00–1.19, p =0.053, 68 comparisons, 40,746 patients; difference-p =0.038). In direct comparisons, variability in SBP was also significantly lower with β1-selective vs nonselective β-blockers (VR=0.81, 0.68–0.97, p =0.03, 18 comparisons, 954 patients). In comparisons with other antihypertensives, the increase in stroke risk with nonselective β-blockers ([OR]=2.29, 1.32–3.96, p =0.002) was more marked than with β1-selective agents (OR=1.24, 1.08–1.42, p =0.003, difference-p =0.03), as was the risk of stroke relative to the risk of myocardial infarction: OR=1.50 (0.93–2.42) vs 0.99 (0.82–1.19).
Conclusion: Use of β1-selective rather than nonselective agents may be advisable when β-blockers are indicated for patients at risk of stroke. Neurology® 2011;77:731–737
GLOSSARY
- BP=
- blood pressure;
- CI=
- confidence interval;
- DBP=
- diastolic blood pressure;
- MI=
- myocardial infarction;
- MRC=
- Medical Research Council;
- OR=
- odds ratio;
- RCT=
- randomized controlled trial;
- rOR=
- relative odds ratio;
- SBP=
- systolic blood pressure;
- VR=
- ratio of the variances
Footnotes
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Study funding: Dr Alastair Webb is in receipt of an NIHR Biomedical Research Centre (Oxford) Clinical Fellowship. Prof. P.M. Rothwell is in receipt of an NIHR Senior Investigator award.
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Editorial, page 708
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Supplemental data at www.neurology.org
- Received December 21, 2010.
- Accepted March 10, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
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- Re:Blood pressure variability and beta-blockers are related to stroke risk
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- Blood pressure variability and beta-blockers are related to stroke risk
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