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
| Autor: | Bath, Pm, Woodhouse, L, Scutt, P, Krishnan, K, Wardlaw, Jm, Bereczki, D, Sprigg, N, Berge, E, Beridze, M, Caso, V, Chen, C, Christensen, H, Collins, R, EL ETRIBI, A, Laska, Ac, Lees, Kr, Ozturk, S, Phillips, S, Pocock, S, DE SILVA HA, Szatmari, S, Utton, S, ENOS Trial Investigators, Carolei, Antonio, Sacco, Simona |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
Vasodilator Agents 030204 cardiovascular system & hematology Nitric oxide law.invention Brain Ischemia Brain ischemia 03 medical and health sciences chemistry.chemical_compound Nitroglycerin 0302 clinical medicine Randomized controlled trial Modified Rankin Scale law 80 and over Odds Ratio Medicine Aged Aged 80 and over Antihypertensive Agents Cerebral Hemorrhage Disease Management Female Humans Hypertension Middle Aged Recovery of Function Single-Blind Method Stroke Treatment Outcome Medicine (all) cardiovascular diseases business.industry General Medicine Odds ratio medicine.disease 3. Good health Mean blood pressure Blood pressure chemistry Anesthesia business 030217 neurology & neurosurgery |
| Zdroj: | 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 ', The Lancet, vol. 385, no. 9968, pp. 617-628 . https://doi.org/10.1016/S0140-6736(14)61121-1 |
| ISSN: | 1474-547X 0140-6736 |
| DOI: | 10.1016/S0140-6736(14)61121-1 |
| Popis: | 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 pInterpretation: In patients with acute stroke and high blood pressure, transdermal glyceryl trinitrate lowered blood pressure and had acceptable safety but did not improve functional outcome. We show no evidence to support continuing prestroke antihypertensive drugs in patients in the first few days after acute stroke.Funding: UK Medical Research Council. |
| Databáze: | OpenAIRE |
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