Ahmed HM, Aimen UE. Esmolol in acute ischemic stroke thrombolysis: Benefits confined to atrial fibrillation and hypertensive patients. World J Clin Cases 2026; 14(17): 120665 [DOI: 10.12998/wjcc.v14.i17.120665]
Corresponding Author of This Article
Hafiz M Ahmed, MD, Department of Medicine, Punjab Medical College, Faisalabad Medical University, Sarogdha Road, Faisalabad 38000, Pakistan. mohammadahmed818@yahoo.com
Research Domain of This Article
Clinical Neurology
Article-Type of This Article
editorial
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World J Clin Cases. Jun 16, 2026; 14(17): 120665 Published online Jun 16, 2026. doi: 10.12998/wjcc.v14.i17.120665
Esmolol in acute ischemic stroke thrombolysis: Benefits confined to atrial fibrillation and hypertensive patients
Hafiz M Ahmed, Umm E Aimen
Hafiz M Ahmed, Umm E Aimen, Department of Medicine, Punjab Medical College, Faisalabad Medical University, Faisalabad 38000, Pakistan
Co-first authors: Hafiz M Ahmed and Umm E Aimen.
Author contributions: Ahmed HM and Aimen UE contributed equally to this work as co-first authors; Ahmed HM conceived the manuscript idea, developed the overall concept of the article, and supervised the project; Aimen UE contributed to the literature review and drafting of key sections. Both authors contributed to manuscript writing, critical revision for important intellectual content, and approved the final version of the manuscript.
AI contribution statement: AI tools (ChatGPT and Claude) were used in a limited capacity solely for language editing, including correction of grammar, punctuation, and improvement of clarity. These tools were applied only after the original manuscript had been written by the authors. AI tools were used only for minor language polishing and did not contribute to the scientific content, data analysis, or generation of results. AI tools did not contribute to the study design, methodology, or interpretation of findings.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Hafiz M Ahmed, MD, Department of Medicine, Punjab Medical College, Faisalabad Medical University, Sarogdha Road, Faisalabad 38000, Pakistan. mohammadahmed818@yahoo.com
Received: March 6, 2026 Revised: April 9, 2026 Accepted: May 11, 2026 Published online: June 16, 2026 Processing time: 89 Days and 15.4 Hours
Core Tip
Core Tip: Esmolol, an ultrashort-acting beta-1 selective blocker, is increasingly used for pre-thrombolysis blood pressure control in acute ischemic stroke, but evidence for its safety in this setting is limited. In a study of 149 patients with acute ischemic stroke undergoing intravenous thrombolysis, Papamichalis et al report that esmolol-treated patients showed significantly worse 3-month functional outcomes, defined by modified Rankin Scale score > 2, compared with untreated patients. Subgroup analyses revealed that this harm was confined to patients without atrial fibrillation and those without a history of hypertension, while outcomes were not significantly different in patients with atrial fibrillation or established hypertension. These data support individualized antihypertensive selection and underscore the need for prospective trials in this underexplored but clinically critical area.
