Published online Mar 16, 2026. doi: 10.12998/wjcc.v14.i8.117167
Revised: January 31, 2026
Accepted: February 25, 2026
Published online: March 16, 2026
Processing time: 106 Days and 9.2 Hours
Arterial blood pressure (ABP) management is critical in the acute phase of an ischemic stroke, especially during intravenous thrombolysis (IT). Esmolol is one of the commonly prescribed antihypertensive agents for managing ABP.
To examine a possible neuroprotective activity of esmolol in patients with acute ischemic stroke (AIS) undergoing IT.
This study retrospectively examined data from the thrombolysis database of General Hospital of Larissa. The National Institutes of Health Stroke Scale (NIHSS) score, predisposing factors, length of stay (LOS), need for advanced critical/neurocritical care, primary adverse events, mortality, functional outcomes, and 3-month survival rates of 26 patients [mean NIHSS score: 11 (range: 3-23)] who underwent IT with alteplase for AIS and esmolol therapy for control of heart rate and/or ABP management at the acute phase (within the first 72 hours from AIS onset) were compared with those of 123 patients [mean NIHSS score: 11 (range: 2-28)] who underwent alteplase but not esmolol therapy during the same time period for AIS. Subgroup analysis was performed with the following patient groups: Patients without arrhythmia-atrial fibrillation (AF) (n = 95): Esmolol-treated (n = 8) and esmolol-untreated subgroups (n = 87); patients with AF (n = 54): Esmolol-treated (n = 18) and esmolol-untreated subgroups (n = 36); patients with a history of hypertension (n = 97): Esmolol-treated (n = 22) and esmolol-untreated subgroups (n = 75); patients without a history of hypertension (n = 52): Esmolol-treated (n = 4) and esmolol-untreated subgroups (n = 48).
In the overall cohort, the AF (69.2% vs 29.3%; P < 0.001) and hypertension (84.6% vs 61%; P = 0.022) incidence rates at baseline in the esmolol-treated group were higher than those in the esmolol-untreated group. The esmolol-treated group exhibited increased LOS, need for advanced critical/neurocritical care and incidence of poor functional outcome rates (P = 0.001, P = 0.003, and P = 0.023, respectively). Subgroup analysis revealed similar outcomes for patients without AF who underwent IT and esmolol therapy [increased LOS (P = 0.006), need for advanced critical/neurocritical care (P = 0.026), incidence of primary adverse events (P = 0.034), and 3-month mortality rates (P = 0.048)] and those without a history of hypertension who underwent IT and esmolol therapy [increased LOS (P = 0.03), need for advanced critical/neurocritical care (P = 0.003), incidence of primary adverse events (P = 0.013), and poor functional outcome rates (P = 0.019)]. Esmolol usage was not correlated with the clinical outcomes in patients with AF. In patients with a history of hypertension, esmolol usage was correlated only with LOS (P = 0.013).
Our study found that esmolol therapy was correlated with worse outcomes, worse survival rates and more complications in the whole study group, and these effects were more apparent in the subgroups of esmolol-treated patients without AF and without a history of hypertension, while patients with AF presented no differences and patients with a history of hypertension presented minimal differences in outcomes that could be associated with esmolol. Further studies are needed to investigate the role of esmolol at the acute phase of ischemic strokes.
Core Tip: Various drugs, including esmolol, are used for managing elevated arterial blood pressure before intravenous thrombolysis for acute ischemic stroke. This study evaluated baseline characteristics and outcomes of 149 patients with a focus on esmolol-treated and esmolol-untreated groups. Sub-group analysis was performed to compare the outcomes between the esmolol-treated and esmolol-untreated subgroups among the following patient groups: Patients with atrial fibrillation (AF); patients without AF; patients with a history of hypertension; patients without a history of hypertension. Esmolol usage resulted in poor outcomes for the overall cohort, patients without AF, and patients without a history of hypertension but not for patients with AF and patients with a history of hypertension.