Use of calcium channel blockers after stroke is not associated with poor outcome
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- Dowlatshahi, D., Fang, J., Kawaja, M. et al. J Neurol (2006) 253: 1478. doi:10.1007/s00415-006-0249-1
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Control of hypertension is essential for the secondary prevention of stroke. Although several trials have assessed the role of calcium channel blockers (CCBs) in the acute stroke, few address their safety and efficacy in secondary prevention. The recovery process after stroke requires neurite outgrowth, which may be dependent on activation of calcium channels and NMDA receptors. We asked whether treatment of hypertension using CCBs is safe during the recovery of patients following stroke and whether it contributes to their functional outcome.
The Registry of the Canadian Stroke Network provided access to information from 1545 patients with ischemic stroke. Primary outcome variables were mortality and functional outcome, which was assessed using the Stroke Impact Scale-16.
Patients discharged on CCB had a 2.5% 6-month mortality rate compared with 5.5% in those who were not on CCB at discharge (OR 0.38, 95% CI 0.17−0.88). There was no change in 6-month mortality with respect to treatment with ACE-I, B-blockers or diuretics at discharge. Patients that were admitted on CCB had improved SIS-16 at 6-months if they were also discharged on CCB, as compared with patients who had their CCB discontinued (73.8 veas 66.8, p = 0.032).
CCB treatment at the time of discharge did not impede functional recovery, and was associated with reduced mortality and improved SIS-16 at 6 months.