For other outcomes analysed ( major vascular events , death from all causes , death from cardiovascular causes ) , we observed no significant differences between the groups .
There were minor blood pressure reductions in the intervention group .
To date , no available evidence supports the routine use of beta-blockers for secondary prevention after stroke or TIA .
BACKGROUND Stroke affects 15 million people per year worldwide .
Despite recent developments in acute stroke treatment , prevention remains very important .
Stroke has a high rate of recurrence ; therefore secondary prevention is also important .
Many clinical approaches to control risk factors have been proposed .
One of these approaches is the prescription of beta-blockers that have effects beyond the reduction of blood pressure , which can reduce the recurrence of stroke .
OBJECTIVES To evaluate the efficacy of beta-blockers for preventing stroke recurrence and for reducing death and major vascular events in people with a previous stroke or transient ischaemic attack ( TIA ) , and to determine their safety , particularly with regard to the development of diabetes mellitus .
Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial
BACKGROUND The Valsartan Antihypertensive Long-term Use Evaluation ( VALUE ) trial was design ed to test the hypothesis that for the same blood-pressure control , valsartan would reduce cardiac morbidity and mortality more than amlodipine in hypertensive patients at high cardiovascular risk . METHODS 15?245 patients , aged 50 years or older with treated or untreated hypertension and high risk of cardiac events participated in a r and omised , double-blind , parallel-group comparison of therapy based on valsartan or amlodipine . Duration of treatment was event-driven and the trial lasted until at least 1450 patients had reached a primary endpoint , defined as a composite of cardiac mortality and morbidity .  Patients from 31 countries were followed up for a mean of 4.2 years . FINDINGS Blood pressure was reduced by both treatments , but the effects of the amlodipine-based regimen were more pronounced , especially in the early period ( blood pressure 4.0/2.1 mm Hg lower in amlodipine than valsartan group after 1 month ; 1.5/1.3 mm Hg after 1 year ; p<0.001 between groups ) . The primary composite endpoint occurred in 810 patients in the valsartan group ( 10.6 % , 25.5 per 1000 patient-years ) and 789 in the amlodipine group ( 10.4 % , 24.7 per 1000 patient-years ; hazard ratio 1.04 , 95 % CI 0.94 - 1.15 , p=0.49 ) . INTERPRETATION The main outcome of cardiac disease did not differ between the treatment groups . Unequal reductions in blood pressure might account for differences between the groups in cause-specific outcomes . The findings emphasise the importance of prompt blood-pressure control in hypertensive patients at high cardiovascular risk
For other outcomes analysed ( major vascular events , death from all causes , death from cardiovascular causes ) , we observed no significant differences between the groups .
There were minor blood pressure reductions in the intervention group .
To date , no available evidence supports the routine use of beta-blockers for secondary prevention after stroke or TIA .
BACKGROUND Stroke affects 15 million people per year worldwide .
Despite recent developments in acute stroke treatment , prevention remains very important .
Stroke has a high rate of recurrence ; therefore secondary prevention is also important .
Many clinical approaches to control risk factors have been proposed .
One of these approaches is the prescription of beta-blockers that have effects beyond the reduction of blood pressure , which can reduce the recurrence of stroke .
OBJECTIVES To evaluate the efficacy of beta-blockers for preventing stroke recurrence and for reducing death and major vascular events in people with a previous stroke or transient ischaemic attack ( TIA ) , and to determine their safety , particularly with regard to the development of diabetes mellitus .