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Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial

Krishnan, Kailash; Scutt, Polly; Woodhouse, Lisa; Bath, Philip M.; Adami, Alessandro; Becker, Jennifer L.; Cala, Lesley A.; Casado, Ana M.; Chen, Christopher; Dineen, Robert A.; Gommans, John; Koumellis, Panos; Christensen, Hanna; Collins, Ronan; Czlonkowska, Anna; Lees, Kennedy R.; Ntaios, George; Ozturk, Serefnur; Phillips, Stephen J.; Sprigg, Nikola; Szatmari, Szabolcs; Wardlaw, Joanna M.; Bath, Philip M.W.

Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial Thumbnail


Authors

Kailash Krishnan

Polly Scutt

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

Alessandro Adami

Jennifer L. Becker

Lesley A. Cala

Ana M. Casado

Christopher Chen

ROBERT DINEEN rob.dineen@nottingham.ac.uk
Professor of Neuroradiology

John Gommans

Panos Koumellis

Hanna Christensen

Ronan Collins

Anna Czlonkowska

Kennedy R. Lees

George Ntaios

Serefnur Ozturk

Stephen J. Phillips

NIKOLA SPRIGG nikola.sprigg@nottingham.ac.uk
Professor of Stroke Medicine

Szabolcs Szatmari

Joanna M. Wardlaw

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



Abstract

Background and purpose: More than 50% of patients with acute intracerebral haemorrhage (ICH) are taking antihypertensive drugs before ictus. Although antihypertensive therapy should be given long term for secondary prevention, whether to continue or stop such treatment during the acute phase of ICH remains unclear, a question that was addressed in the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Methods: ENOS was an international multicenter, prospective, randomized, blinded endpoint trial. Among 629 patients with ICH and systolic blood pressure between 140 and 220 mmHg, 246 patients who were taking antihypertensive drugs were assigned to continue (n = 119) or to stop (n = 127) taking drugs temporarily for 7 days. The primary outcome was the modified Rankin Score at 90 days. Secondary outcomes included death, length of stay in hospital, discharge destination, activities of daily living, mood, cognition, and quality of life. Results: Blood pressure level (baseline 171/92 mmHg) fell in both groups but was significantly lower at 7 days in those patients assigned to continue antihypertensive drugs (difference 9.4/3.5 mmHg, P < .01). At 90 days, the primary outcome did not differ between the groups; the adjusted common odds ratio (OR) for worse outcome with continue versus stop drugs was .92 (95% confidence interval, .45- 1.89; P = .83). There was no difference between the treatment groups for any secondary outcome measure, or rates of death or serious adverse events. Conclusions: Among patients with acute ICH, immediate continuation of antihypertensive drugs during the first week did not reduce death or major disability in comparison to stopping treatment temporarily.

Citation

Krishnan, K., Scutt, P., Woodhouse, L., Bath, P. M., Adami, A., Becker, J. L., …Bath, P. M. (2016). Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial. Journal of Stroke and Cerebrovascular Diseases, 25(5), 1017-1026. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.01.010

Journal Article Type Article
Acceptance Date Jan 2, 2016
Online Publication Date Feb 4, 2016
Publication Date 2016-05
Deposit Date Sep 30, 2016
Publicly Available Date Mar 29, 2024
Journal Journal of Stroke and Cerebrovascular Diseases
Print ISSN 1052-3057
Electronic ISSN 1532-8511
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 25
Issue 5
Pages 1017-1026
DOI https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.01.010
Keywords Antihypertensive therapy; blood pressure; glyceryl trinitrate; intracerebral hemorrhage; cerebrovascular disorders; randomized controlled trial
Public URL https://nottingham-repository.worktribe.com/output/782261
Publisher URL http://www.sciencedirect.com/science/article/pii/S1052305716000239

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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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