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Low dose beta blockade in acute stroke ("BEST" trial): an evaluation
D H Barer1, J M Cruickshank, S B Ebrahim
1University Hospital, Nottingham.
British Medical Journal (Clinical Research Ed.)
|March 12, 1988
Summary
Beta blockers did not show a protective effect in acute stroke patients in the BEST trial. However, patients already on beta blockers before stroke had better outcomes, suggesting a potential protective role.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Subarachnoid hemorrhage patients showed a protective effect with propranolol.
- The potential benefit of beta blockers in acute stroke was unexplored.
Purpose of the Study:
- To investigate the efficacy of beta blockers (atenolol, propranolol) versus placebo in acute hemispheric stroke patients.
- To evaluate the protective effect of beta blockers on cerebral function in acute stroke.
Main Methods:
- Randomized controlled trial of 302 conscious patients with acute hemispheric stroke (within 48 hours).
- Patients received atenolol, propranolol, or placebo for three weeks.
- Comparison with 60 patients already on beta blockers pre-stroke.
Main Results:
- No significant protective effect of initiated beta blockers observed; early deaths were higher in beta blocker groups, explained by baseline differences.
- Patients pre-treated with beta blockers demonstrated considerably better outcomes.
- Suggests prior beta blocker use may be protective in acute stroke.
Conclusions:
- The study did not confirm a benefit of initiating beta blockers for acute stroke treatment.
- Further research is warranted to explore the potential protective role of pre-existing beta blocker therapy.
- The trial design allows for practical evaluation of treatments in realistic conditions.