What is the efficacy and safety of enalapril and propranolol in improving neurologic recovery after severe traumatic brain injury (TBI)?

Enalapril is an ACE inhibitor commonly used to manage hypertension and heart failure. It has been suggested to have neuroprotective properties.
Propranolol is a beta-blocker used to manage hypertension and other cardiovascular conditions. It has been proposed to have potential benefits in stabilizing cardiovascular status and improving outcomes in TBI patients.
Both medications have been hypothesized to provide cardiovascular stability without negatively impacting neurologic recovery after severe TBI.

Efficacy and Safety: The study found that both enalapril and propranolol, either alone or in combination, are effective and safe in maintaining cardiovascular stability and do not negatively impact neurologic recovery after severe TBI.
Neurologic Outcomes: Propranolol showed a slightly better effect on long-term Glasgow Outcome Scale-extended (GOS-E) scores compared to other treatment strategies, indicating improved neurologic recovery.
Mortality and Other Outcomes: There was no significant difference in mortality rate, ventilator dependency, hospital length of stay, or speech function (measured by the Apraxia of Speech Rating Scale) among the groups treated with enalapril, propranolol, or both compared to the control group.
Conclusion: Enalapril and propranolol are both effective and safe for use in severe TBI patients. Propranolol may offer a slight advantage in long-term neurologic recovery, but larger randomized controlled trials are recommended to further validate these findings.