Beta-blockers for preventing stroke recurrence

Detalhes bibliográficos
Autor(a) principal: De Lima, Luiz Gustavo [UNIFESP]
Data de Publicação: 2014
Outros Autores: Saconato, Humberto, Atallah, Alvaro N., Silva, Edina M. K. da [UNIFESP]
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: http://dx.doi.org/10.1002/14651858.CD007890.pub3
http://repositorio.unifesp.br/handle/11600/37103
Resumo: BackgroundStroke 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.ObjectivesTo 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.Search methodsWe 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.Selection criteriaRandomised 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.Data collection and analysisTwo review authors independently screened the trials identified, appraised quality, and extracted data.Main resultsWe 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).Authors' conclusionsTo 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.
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spelling Beta-blockers for preventing stroke recurrenceAdrenergic beta-1 Receptor Antagonists [therapeutic use]Atenolol [therapeutic use]Cause of DeathIschemic Attack, Transient [complications]Myocardial Infarction [mortality]Recurrence [prevention & control]Secondary Prevention [methods]Stroke [prevention & control]HumansBackgroundStroke 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.ObjectivesTo 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.Search methodsWe 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.Selection criteriaRandomised 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.Data collection and analysisTwo review authors independently screened the trials identified, appraised quality, and extracted data.Main resultsWe 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).Authors' conclusionsTo 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.Universidade Federal de São Paulo, Brazilian Cochrane Ctr, BR-04038000 São Paulo, SP, BrazilSanta Casa Campo Mourao, Dept Med, São Paulo, BrazilCtr Estudos Saude Baseada Evidencias & Avaliacao, Brazilian Cochrane Ctr, São Paulo, BrazilUniversidade Federal de São Paulo, BR-04038000 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Brazilian Cochrane Ctr, BR-04038000 São Paulo, SP, BrazilUniversidade Federal de São Paulo, BR-04038000 São Paulo, SP, BrazilWeb of ScienceBrazilian Cochrane Centre, BrazilCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Comissao de Aperfeicoamento de Pessoal de Ensino SuperiorWiley-BlackwellUniversidade Federal de São Paulo (UNIFESP)Santa Casa Campo MouraoCtr Estudos Saude Baseada Evidencias & AvaliacaoDe Lima, Luiz Gustavo [UNIFESP]Saconato, HumbertoAtallah, Alvaro N.Silva, Edina M. K. da [UNIFESP]2016-01-24T14:34:54Z2016-01-24T14:34:54Z2014-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion25http://dx.doi.org/10.1002/14651858.CD007890.pub3Cochrane Database of Systematic Reviews. Hoboken: Wiley-Blackwell, n. 10, 25 p., 2014.10.1002/14651858.CD007890.pub31469-493Xhttp://repositorio.unifesp.br/handle/11600/37103WOS:000347646000039engCochrane Database of Systematic Reviewsinfo:eu-repo/semantics/openAccesshttp://olabout.wiley.com/WileyCDA/Section/id-406071.htmlreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2023-03-27T16:19:32Zoai:repositorio.unifesp.br/:11600/37103Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652023-03-27T16:19:32Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Beta-blockers for preventing stroke recurrence
title Beta-blockers for preventing stroke recurrence
spellingShingle Beta-blockers for preventing stroke recurrence
De Lima, Luiz Gustavo [UNIFESP]
Adrenergic beta-1 Receptor Antagonists [therapeutic use]
Atenolol [therapeutic use]
Cause of Death
Ischemic Attack, Transient [complications]
Myocardial Infarction [mortality]
Recurrence [prevention & control]
Secondary Prevention [methods]
Stroke [prevention & control]
Humans
title_short Beta-blockers for preventing stroke recurrence
title_full Beta-blockers for preventing stroke recurrence
title_fullStr Beta-blockers for preventing stroke recurrence
title_full_unstemmed Beta-blockers for preventing stroke recurrence
title_sort Beta-blockers for preventing stroke recurrence
author De Lima, Luiz Gustavo [UNIFESP]
author_facet De Lima, Luiz Gustavo [UNIFESP]
Saconato, Humberto
Atallah, Alvaro N.
Silva, Edina M. K. da [UNIFESP]
author_role author
author2 Saconato, Humberto
Atallah, Alvaro N.
Silva, Edina M. K. da [UNIFESP]
author2_role author
author
author
dc.contributor.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
Santa Casa Campo Mourao
Ctr Estudos Saude Baseada Evidencias & Avaliacao
dc.contributor.author.fl_str_mv De Lima, Luiz Gustavo [UNIFESP]
Saconato, Humberto
Atallah, Alvaro N.
Silva, Edina M. K. da [UNIFESP]
dc.subject.por.fl_str_mv Adrenergic beta-1 Receptor Antagonists [therapeutic use]
Atenolol [therapeutic use]
Cause of Death
Ischemic Attack, Transient [complications]
Myocardial Infarction [mortality]
Recurrence [prevention & control]
Secondary Prevention [methods]
Stroke [prevention & control]
Humans
topic Adrenergic beta-1 Receptor Antagonists [therapeutic use]
Atenolol [therapeutic use]
Cause of Death
Ischemic Attack, Transient [complications]
Myocardial Infarction [mortality]
Recurrence [prevention & control]
Secondary Prevention [methods]
Stroke [prevention & control]
Humans
description BackgroundStroke 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.ObjectivesTo 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.Search methodsWe 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.Selection criteriaRandomised 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.Data collection and analysisTwo review authors independently screened the trials identified, appraised quality, and extracted data.Main resultsWe 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).Authors' conclusionsTo 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.
publishDate 2014
dc.date.none.fl_str_mv 2014-01-01
2016-01-24T14:34:54Z
2016-01-24T14:34:54Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1002/14651858.CD007890.pub3
Cochrane Database of Systematic Reviews. Hoboken: Wiley-Blackwell, n. 10, 25 p., 2014.
10.1002/14651858.CD007890.pub3
1469-493X
http://repositorio.unifesp.br/handle/11600/37103
WOS:000347646000039
url http://dx.doi.org/10.1002/14651858.CD007890.pub3
http://repositorio.unifesp.br/handle/11600/37103
identifier_str_mv Cochrane Database of Systematic Reviews. Hoboken: Wiley-Blackwell, n. 10, 25 p., 2014.
10.1002/14651858.CD007890.pub3
1469-493X
WOS:000347646000039
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Cochrane Database of Systematic Reviews
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
http://olabout.wiley.com/WileyCDA/Section/id-406071.html
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dc.format.none.fl_str_mv 25
dc.publisher.none.fl_str_mv Wiley-Blackwell
publisher.none.fl_str_mv Wiley-Blackwell
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
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instname_str Universidade Federal de São Paulo (UNIFESP)
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reponame_str Repositório Institucional da UNIFESP
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