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Impact of hydration status on haemodynamics, effects of acute blood pressure lowering treatment, and prognosis after stroke

Billington, Charlotte K.; Appleton, Jason P.; Berge, Eivind; Sprigg, Nikola; Glover, Mark; Bath, Philip M.W.

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Charlotte K. Billington

Jason P. Appleton

Eivind Berge

Professor of Stroke Medicine

Mark Glover

Stroke Association Professor of Stroke Medicine



High blood pressure (BP) is common in acute stroke and associated with poor outcome, but the Efficacy of Nitric Oxide in Stroke (ENOS) trial showed no beneficial effect of antihypertensive treatment in this situation. Antihypertensive agents have accentuated effects in dehydrated patients. We assessed the impact of dehydration on haemodynamics, effects of antihypertensive treatment and prognosis in the ENOS trial.


ENOS randomised 4011 patients with acute stroke and raised systolic BP to glyceryl trinitrate (GTN) patch or no GTN, and to continue or to stop existing antihypertensive treatment within 48 hours of onset. The primary outcome was functional outcome (modified Rankin Scale, mRS) at day 90. Blood markers of dehydration at baseline were collected at two sites (n=310) and their relation to haemodynamics and outcome was assessed.


There were no significant associations between dehydration markers and fall in blood pressure from baseline to day 1, and no significant interaction with allocated treatment. Overall, increasing urea was associated with an unfavourable shift in mRS (OR 3.43, 95% CI 1.42 to 8.32, p=0.006) and increased risk of death at day 90 (HR 4.55, 95% CI 1.51 to 13.66, p=0.007).


Blood pressure lowering treatment was safe in dehydrated patients, with no precipitous changes in BP, this supporting its use in acute stroke prior to blood markers of dehydration becoming available. Increased baseline urea was associated with poor prognosis after stroke.

Journal Article Type Article
Acceptance Date Aug 28, 2018
Online Publication Date Sep 8, 2018
Publication Date Dec 1, 2018
Deposit Date Oct 9, 2018
Publicly Available Date Nov 28, 2018
Journal British Journal of Clinical Pharmacology
Print ISSN 0306-5251
Electronic ISSN 1365-2125
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 84
Issue 12
Pages 2914-2922
Keywords Dehydration; Blood pressure; Acute stroke; Ischaemic stroke; Intracerebral haemorrhage; Glyceryl trinitrate; Nitrate
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