The Influence Of Prestroke Betaloc On Stroke Associated Pneumonia And Stroke Outcome

Objective: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.Previous researches mostly focused on animals in spite of in human beings.Therefore,clinical studies are imperative to verify the effectiveness of BB.As one of the most widely used BB,the security and the effect of betaloc has been widely acknowledged.We aimed to examine the effects of pre-stroke BB exposure on mortality,functional outcome,and occurrence of pneumonia after ischemic stroke.Methods:The study involved stroke patients who were hospitalized in Neurology Department of Southeast Affiliated Zhongda Hospital from January to December in 2016.Data including standard demographic as well as clinical variables(age,sex,history of atrial fibrillation,hypertension,diabetes mellitus,coronary heart disease,COPD,smoking and drinking history,admission stroke severity by National Institutes of Health Stroke Score[NIHSS],admission albumin level).Therefore,the main evaluation indexes were incidence of SAP,functional outcome defined using modified Rankin Scale and Bathel score at 3 months.Our study mainly aimed at evaluating the influence of betaloc on SAP and stroke outcome.To exclude the antihypertensive effect of betaloc on stroke prognosis,our sdudy also recorded the hypertensive patients’ medication and analyzed the distribution of the antihypertensive drugs.Therefore we used multivariable Poisson regression in statistical analysis to exclude the intervention of other confounding factors.Result:In total,227 patients were analyzed in our study.A total of 42(18.5%)patients were treated with betaloc before stroke onset.The incidence of SAP among all these patients is 28.2%.Prestroke betaloc not only showed association with mortality(P<0.001),but also had close relationship with functional outcome,estimate either through modified Rankin score(P=0.024)or through Bathel socre(P=0.006).The distribution of other antihypertensive drugs in these two groups showed no significantly difference(P=0.142).Moreover,admission NIHSS is associated with stroke mortiliy and oucome(Rankin and Bathel P<0.001).Admission albumin level suggested to have effect on stroke outcome(Rankin P=0.035).In addition,history of atrial fibrillation(P=0.044),hypertension(P=0.049),coronary heart disease(P=0.035),admission albumin level(P=0.032)and admission NIHSS(P<0.001)were all associated with mortility in 3 months after stroke.Taken betaloc before stroke was verified to make no significantly difference on frequency of SAP.Moreover,admission NIHSS(P<0.001)and atrial fibrillation(P=0.015)were verified to be associated with SAP.Conclusions:After excluding the effects of the confounding factors such as admission NIHSS,albumin level,past medical history,prestroke betaloc were not significantly associated with incidence of SAP.However,taken betaloc before stroke was verified to benefit the prognosis,either in terms of survival time or the quality of life.