It is safe to use transdermal glyceryl trinitrate to lower blood pressure in patients with acute ischaemic stroke with carotid stenosis

Appleton, Jason P.; Woodhouse, Lisa J.; Belcher, Andrew; Bereczki, Daniel; Berge, Eivind; Caso, Valeria; Chang, Hui Meng; Christensen, Hanne K; Collins, Ronan; Gommans, John; Laska, Ann C; Ntaios, George; Ozturk, Serefnur; Sare, Gillian M; Szatmari, Szabolcs; Wang, Yongjun; Wardlaw, Joanna M; Sprigg, Nikola; Bath, Philip M

Abstract

Background There is concern that blood pressure (BP) lowering in acute stroke may compromise cerebral perfusion and worsen outcome in the presence of carotid stenosis. We assessed the effect of glyceryl trinitrate (GTN) in patients with carotid stenosis using data from the Efficacy of Nitric Oxide in Stroke (ENOS) Trial.

Methods ENOS randomised 4011 patients with acute stroke and raised systolic BP (140–220 mm Hg) to transdermal GTN or no GTN within 48 hours of onset. Those on prestroke antihypertensives were also randomised to stop or continue their medication for 7 days. The primary outcome was the modified Rankin Scale (mRS) at day 90. Ipsilateral carotid stenosis was split:

Citation

Appleton, J. P., Woodhouse, L. J., Belcher, A., Bereczki, D., Berge, E., Caso, V., Chang, H. M., Christensen, H. K., Collins, R., Gommans, J., Laska, A. C., Ntaios, G., Ozturk, S., Sare, G. M., Szatmari, S., Wang, Y., Wardlaw, J. M., Sprigg, N., & Bath, P. M. (2019). It is safe to use transdermal glyceryl trinitrate to lower blood pressure in patients with acute ischaemic stroke with carotid stenosis. Stroke and Vascular Neurology, 4(1), 28-35. https://doi.org/10.1136/svn-2019-000232

• Journal Article Type: Article
• Acceptance Date: Feb 21, 2019
• Online Publication Date: Mar 19, 2019
• Publication Date: Mar 25, 2019
• Deposit Date: May 7, 2019
• Publicly Available Date: May 7, 2019
• Journal: Stroke and Vascular Neurology
• Electronic ISSN: 2059-8696
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 4
• Issue: 1
• Pages: 28-35
• DOI: https://doi.org/10.1136/svn-2019-000232
• Public URL: https://nottingham-repository.worktribe.com/output/2026038
• Publisher URL: https://svn.bmj.com/content/4/1/28
• Contract Date: May 7, 2019