gms | German Medical Science

Objective: Previous studies have shown that preadmission betablockers (BB) could possibly be associated with cardioprotective and vasospasm-reducing benefits. Nebivolol has specifically been shown to increase nitric oxide levels and decrease oxidative stress after SAH. The aim of this study was to elucidate whether betablockers have an effect on vasospasm and/or vasospasm-related infarction, mortality and unfavorable outcome.

Methods: A retrospective analysis of all SAH patients treated at our single university center from 2007-2017 was performed. Data were obtained from the electronic patient chart, discharge summaries and questionnaires sent to all patients to determine the administration of beta blockers before the SAH. The following variables were dichotomized: Hunt and Hess grade and outcome according to the modified Rankin scale (mRS). Chi-squared and multiple logistic regression were performed with SPSS. P<0.05 was considered significant.

Results: Among the 397 patients, data on medication prior to admission was available for 148 patients (37 with BB, 110 without BB). 109 patients had an angiographic confirmation of aneurysm (aSAH), 38 were non-aneurysmal (naSAH). 394 patients (129 with BB, 265 without BB) were included for analyses on BB usage on discharge. Among these, 306 patients had an angiographic confirmation of aneurysm, 81 were non-aneurysmal. Most aneurysmal patients had pretreatment with metoprolol (n=20) and in naSAH patients, metoprolol (n=2) and bisoprolol (n=2) were the most common preadmission BB. Nearly all patients were discharged with metoprolol (n=98/105 in aneurysmal, n=18/22 in naSAH). Preadmission BB were a significant factor for mortality in univariate analysis (p=0.00) in aSAH. Preadmission BB usage was also associated with an increased OR for mortality in multiple logistic regression analyses after correcting for age and Hunt & Hess grade (OR 3.19, CI: 1.0-10.0, p=0.046), whereas discharge with BB was associated with a lower OR for mortality (OR 0.046, CI: 0.01-0.13, p=0.00) and a higher OR for good outcome at 6 months (OR 3.17, CI: 1.51-6.65, p=0.002).Preadmission BB had no effects on vasospasm and/or associated infarction. For the naSAH group, no effects were found between BB use and vasospasm, vasospasm-associated infarction, death or outcome.

Conclusion: The role of preadmission BB is unclear. BB use on discharge may lower the risk of mortality and may be associated with a better outcome in aSAH patients.