Stroke, Vol 24, 543-548, Copyright © 1993 by American Heart Association
BACKGROUND AND PURPOSE: beta-Blockers prevent vascular events in patients
after myocardial infarction and lower blood pressure, the main risk factor
for stroke. Hence, we assessed the effects of atenolol on the occurrence of
death from vascular causes, stroke, or myocardial infarction and on blood
pressure in patients after a transient ischemic attack or nondisabling
ischemic stroke. METHODS: In a double-blind, placebo-controlled randomized
clinical trial we studied the occurrence of the outcome event death from
vascular causes, nonfatal stroke, or nonfatal myocardial infarction and the
outcome event fatal or nonfatal stroke as well as blood pressure on
follow-up. A total of 1,473 aspirin- treated patients with transient
ischemic attack or nondisabling ischemic stroke were randomized to 50 mg
atenolol daily or placebo. The mean follow-up was 2.6 years. RESULTS:
Patients on atenolol had a risk of 97/732 (13.3%) for the combined outcome
event versus a risk of 95/741 (12.8%) for those on placebo (adjusted hazard
ratio, 1.00; 95% confidence interval, 0.76-1.33). The adjusted hazard ratio
for fatal or nonfatal stroke was 0.82 (95% confidence interval, 0.57-1.19).
More patients on beta-blocker (153) reported adverse effects than on
placebo (103). At the first follow-up visit after randomization (median at
4 months) systolic blood pressure in the atenolol group had dropped by 8.0
mm Hg compared with 2.2 mm Hg in the placebo group (difference, 5.8 mm Hg;
95% confidence interval, 2.9-8.6 mm Hg). For diastolic blood pressure this
difference was 2.9 mm Hg (95% confidence interval, 1.5- 4.4 mm Hg).
CONCLUSIONS: Our data neither confirm nor rule out that atenolol prevents
important vascular events in patients after transient ischemic attack or
nondisabling ischemic stroke, given the modest effect on blood pressure,
the restrictions in patient selection, and the limited number of
patient-years.
ARTICLES
Trial of secondary prevention with atenolol after transient ischemic attack or nondisabling ischemic stroke. The Dutch TIA Trial Study Group
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