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.

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.

Citation

Sandset, E. C., Appleton, J. P., Berge, E., Christensen, H., Gommans, J., Krishnan, K., Ntaios, G., Phillips, S., Pocock, S., Sprigg, N., Woodhouse, L. J., & 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

• Journal Article Type: Article
• Acceptance Date: Apr 20, 2019
• Online Publication Date: Jul 1, 2019
• Publication Date: Oct 1, 2019
• Deposit Date: May 7, 2019
• Publicly Available Date: Jul 2, 2020
• Journal: Journal of Hypertension
• Electronic ISSN: 1473-5598
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 37
• Issue: 10
• Pages: 2104-2109
• DOI: https://doi.org/10.1097/HJH.0000000000002154
• Keywords: Acute stroke; blood pressure; glyceryl trinitrate
• Public URL: https://nottingham-repository.worktribe.com/output/2025896
• 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
• Contract Date: May 7, 2019