Protective effects of beta-blockers in cerebrovascular disease. Neurology. 2007;Feb 13;68(7):509-514.

Because activated sympathetic tone is associated with poorer outcome after stroke, the authors investigated whether beta-blocker treatment was associated with lesser stroke severity and improved outcome. Researchers prospectively studied 111 patients with stroke. Stroke severity on presentation was gauged by the Canadian Neurologic Scale (CanNS) and medication use was verified from medical records. Power spectral analysis of heart rate variability estimated cardiac sympathovagal tone. Coagulation and inflammatory activity were assessed. 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 A1C levels (P = 0.02); and erythrocyte sedimentation rate (P = 0.003). 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 A1C.