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Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomised controlled trial

Bath, Philip M.W.

Authors

PHILIP BATH philip.bath@nottingham.ac.uk
Stroke Association Professor of Stroke Medicine



Abstract

Background

High blood pressure is associated with poor outcome after stroke. Whether blood pressure should be lowered early after stroke, and whether to continue or temporarily withdraw existing antihypertensive drugs, is not known. We assessed outcomes after stroke in patients given drugs to lower their blood pressure.
Methods

In our multicentre, partial-factorial trial, we randomly assigned patients admitted to hospital with an acute ischaemic or haemorrhagic stroke and raised systolic blood pressure (systolic 140–220 mm Hg) to 7 days of transdermal glyceryl trinitrate (5 mg per day), started within 48 h of stroke onset, or to no glyceryl trinitrate (control group). A subset of patients who were taking antihypertensive drugs before their stroke were also randomly assigned to continue or stop taking these drugs. The primary outcome was function, assessed with the modified Rankin Scale at 90 days by observers masked to treatment assignment. This study is registered, number ISRCTN99414122.
Findings

Between July 20, 2001, and Oct 14, 2013, we enrolled 4011 patients. Mean blood pressure was 167 (SD 19) mm Hg/90 (13) mm Hg at baseline (median 26 h [16–37] after stroke onset), and was significantly reduced on day 1 in 2000 patients allocated to glyceryl trinitrate compared with 2011 controls (difference −7·0 [95% CI −8·5 to −5·6] mm Hg/–3·5 [–4·4 to −2·6] mm Hg; both p

Journal Article Type Article
Publication Date Feb 14, 2015
Journal The Lancet
Print ISSN 0140-6736
Electronic ISSN 1474-547X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 385
Issue 9968
APA6 Citation Bath, P. M. (2015). Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomised controlled trial. Lancet, 385(9968), https://doi.org/10.1016/S0140-6736%2814%2961121-1
DOI https://doi.org/10.1016/S0140-6736%2814%2961121-1
Publisher URL http://www.sciencedirect.com/science/article/pii/S0140673614611211
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0
Additional Information Acceptance date is estimated. :: Article attributed to ENOS Trial Investigators. Writing committee: Philip M W Bath, Lisa Woodhouse, Polly Scutt, Kailash Krishnan, Joanna M Wardlaw, Daniel Bereczki, Nikola Sprigg, Eivind Berge, Maia Beridze, Valeria Caso, Christopher Chen, Hanne Christensen, Ronan Collins, Anwar El Etribi, Ann Charlotte Laska, Kennedy R Lees, Serefnur Ozturk, Steve Phillips, Stuart Pocock, H Asita de Silva, Szabolcs Szatmari, Sally Utton.

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ENOS Bath Efficacy of nitric oxide Lancet 2015.pdf (642 Kb)
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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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