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Associations between change in blood pressure and functional outcome, early events and death: results from the Efficacy of Nitric Oxide in Stroke trial

Sandset, Else C.; Appleton, Jason P.; Berge, Eivind; Christensen, Hanne; Gommans, John; Krishnan, Kailash; Ntaios, George; Phillips, Stephen; Pocock, Stuart; Sprigg, Nikola; Woodhouse, Lisa J.; Bath, Philip M.

Authors

Else C. Sandset

Jason P. Appleton

Eivind Berge

Hanne Christensen

John Gommans

Kailash Krishnan

George Ntaios

Stephen Phillips

Stuart Pocock

Nikola Sprigg

Lisa J. Woodhouse

Philip M. Bath



Abstract

Objectives: High blood pressure (BP) is associated with a poor outcome after acute stroke. Early reduction in blood pressure (BP) may be associated with fewer early adverse events and deaths, and improved functional outcome.
Methods: Analyses used data from the Efficacy of Nitric Oxide in Stroke (ENOS) trial, a multicentre randomised single-masked and outcome-masked trial of glyceryl trinitrate (GTN) vs. no GTN in 4,011 patients recruited within 48 hours of an ischaemic or haemorrhagic stroke and with raised systolic BP (SBP 140-220mmHg). Change in SBP from baseline to day 1 was categorised as: >15% decrease, 15-5% decrease, 5% decrease to 5% increase (no change - reference), and >5% increase. The primary outcome was functional outcome (modified Rankin Scale [mRS]) score at 90 days.
Results: Across all patients, both moderate (5–15%) and large (>15%) decreases in SBP were associated with beneficial shifts in the mRS relative to patients with no change in blood pressure: adjusted common odds ratio (acOR) 0.81 (95% CI 0.70–0.90) and OR 0.84 (95% CI 0.71–1.00) respectively. A moderate decrease in SBP was also associated with a lower risk of early adverse events, aOR 0.69 (95% CI 0.52–0.90).
Conclusion: Modest decreases in SBP in acute stroke appear to be associated with fewer early events and better long-term functional outcome.

Journal Article Type Article
Publication Date Oct 1, 2019
Journal Journal of Hypertension
Electronic ISSN 1473-5598
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 37
Issue 10
Pages 2104-2109
APA6 Citation Sandset, E. C., Appleton, J. P., Berge, E., Christensen, H., Gommans, J., Krishnan, K., …Bath, P. M. (2019). Associations between change in blood pressure and functional outcome, early events and death: results from the Efficacy of Nitric Oxide in Stroke trial. Journal of Hypertension, 37(10), 2104-2109. https://doi.org/10.1097/HJH.0000000000002154
DOI https://doi.org/10.1097/HJH.0000000000002154
Keywords Acute stroke; blood pressure; glyceryl trinitrate
Publisher URL https://journals.lww.com/jhypertension/fulltext/2019/10000/Associations_between_change_in_blood_pressure_and.24.aspx
Related Public URLs https://insights.ovid.com/crossref?an=00004872-900000000-97166

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