Present perspectives of therapy in the prevention of stroke: beta blockers

Stroke represents the third most common cause of death in the developed world and is also a very significant cause of morbidity. Epidemiological data clearly show that hypertension is associated with an increased risk of stroke. In randomized controlled clinical trials, treatment for hypertension has been shown to reduce stroke events (both fatal and non-fatal) by 40% in all hypertensive populations. In fact, a reduction in the incidence of stroke has been demonstrated in middle-aged as well as in older hypertensive patients, and in all grades of hypertension. Beta blockers are one of the first-line therapeutic alternatives in the field of hypertension. Their role appears strongly supported also by the results of some large intervention trials in hypertensive patients. Beta blockers may have, however, different effects on the prevention of coronary events and sudden death from those of other antihypertensive drugs (i.e. diuretics), even if the benefit in terms of stroke prevention seems quite similar. Therefore the choice of the best mean of optimizing blood pressure control requires additional clinical considerations, such as the age of the patient, the presence of other risk factors and the presence of myocardial ischemia.