Abstract
BackgroundThe prognostic impact of preadmission use of calcium channel blockers (CCBs) and beta blockers (BBs) on stroke mortality remains unclear. We aimed to examine whether preadmission use of CCBs or BBs was associated with improved short-term mortality following ischemic stroke, intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH).MethodsWe conducted a nationwide population-based cohort study using Danish medical registries. We identified all patients with a first-time inpatient diagnosis of stroke between 2004 and 2012 and their comorbidities. We defined CCB/BB use as current use, former use, or non-use. Current use was further classified as new or long-term use. We used Cox regression modeling to compute 30-day mortality rate ratios (MRRs) with 95% confidence intervals (CIs), controlling for potential confounders.ResultsWe identified 100,043 patients with a first-time stroke. Of these, 83,736 (83.7%) patients had ischemic stroke, 11,779 (11.8%) had ICH, and 4,528 (4.5%) had SAH. Comparing current users of CCBs or BBs with non-users, we found no association with mortality for ischemic stroke [adjusted 30-day MRR = 0.99 (95% CI: 0.94-1.05) for CCBs and 1.01 (95% CI: 0.96-1.07) for BBs], ICH [adjusted 30-day MRR = 1.05 (95% CI: 0.95-1.16) for CCBs and 0.95 (95% CI: 0.87-1.04) for BBs], or SAH [adjusted 30-day MRR = 1.05 (95% CI: 0.85-1.29) for CCBs and 0.89 (95% CI: 0.72-1.11) for BBs]. Former use of CCBs or BBs was not associated with mortality.ConclusionsPreadmission use of CCBs or BBs was not associated with 30-day mortality following ischemic stroke, ICH, or SAH.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0279-3) contains supplementary material, which is available to authorized users.
Highlights
The prognostic impact of preadmission use of calcium channel blockers (CCBs) and beta blockers (BBs) on stroke mortality remains unclear
Because the association between blood pressure at hospitalization and mortality is U-shaped in stroke [9], and both ischemic and hemorrhagic strokes are associated with transiently elevated blood pressure in the acute phase [10], we hypothesized that preadmission use of CCBs or BBs could reduce short-term mortality through improved blood pressure control
It was established that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were associated with reduced 30-day mortality following ischemic stroke but not haemorrhagic stroke [12]. To investigate whether this protective effect extended to other antihypertensive agents, we examined whether use of CCBs or BBs at time of stroke was associated with reduced short-term mortality
Summary
The prognostic impact of preadmission use of calcium channel blockers (CCBs) and beta blockers (BBs) on stroke mortality remains unclear. We aimed to examine whether preadmission use of CCBs or BBs was associated with improved short-term mortality following ischemic stroke, intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). Thirty-day mortality is approximately 11% for ischemic stroke [5], 34% for intracerebral hemorrhage (ICH) [5], and 29% for subarachnoid hemorrhage (SAH) [6]. Because the association between blood pressure at hospitalization and mortality is U-shaped in stroke [9], and both ischemic and hemorrhagic strokes are associated with transiently elevated blood pressure in the acute phase [10], we hypothesized that preadmission use of CCBs or BBs could reduce short-term mortality through improved blood pressure control
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