It is safe to use transdermal glyceryl trinitrate to lower blood pressure in patients with acute ischaemic stroke with carotid stenosis

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dc.contributor.authorAppleton, Jason P.
dc.contributor.authorWoodhouse, Lisa J.
dc.contributor.authorBelcher, Andrew
dc.contributor.authorBereczki, Daniel
dc.contributor.authorBerge, Eivind
dc.contributor.authorCaso, Valeria
dc.contributor.authorChang, Hui Meng
dc.contributor.authorChristensen, Hanne K
dc.contributor.authorCollins, Ronan
dc.contributor.authorGommans, John
dc.contributor.authorLaska, Ann C
dc.contributor.authorNtaios, George
dc.contributor.authorOzturk, Serefnur
dc.contributor.authorSare, Gillian M
dc.contributor.authorSzatmari, Szabolcs
dc.contributor.authorWang, Yongjun
dc.contributor.authorWardlaw, Joanna M
dc.contributor.authorSprigg, Nikola
dc.contributor.authorBath, Philip M
dc.date.accessioned2020-03-26T20:15:00Z
dc.date.available2020-03-26T20:15:00Z
dc.date.issued2019
dc.departmentSelçuk Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümüen_US
dc.description.abstractBackground There is concern that blood pressure (BP) lowering in acute stroke may compromise cerebral perfusion and worsen outcome in the presence of carotid stenosis. We assessed the effect of glyceryl trinitrate (GTN) in patients with carotid stenosis using data from the Efficacy of Nitric Oxide in Stroke (ENOS) Trial. Methods ENOS randomised 4011 patients with acute stroke and raised systolic BP (140-220 mm Hg) to transdermal GTN or no GTN within 48 hours of onset. Those on prestroke antihypertensives were also randomised to stop or continue their medication for 7 days. The primary outcome was the modified Rankin Scale (mRS) at day 90. Ipsilateral carotid stenosis was split: <30%; 30-<50%; 50-<70%; >= 70%. Data are ORs with 95% CIs adjusted for baseline prognostic factors. Results 2023 (60.5%) ischaemic stroke participants had carotid imaging. As compared with <30%, >= 70% ipsilateral stenosis was associated with an unfavourable shift in mRS (worse outcome) at 90 days (OR 1.88, 95% CI 1.44 to 2.44, p<0.001). Those with >= 70% stenosis who received GTN versus no GTN had a favourable shift in mRS (OR 0.56, 95% CI 0.34 to 0.93, p=0.024). In those with 50-<70% stenosis, continuing versus stopping prestroke antihypertensives was associated with worse disability, mood, quality of life and cognition at 90 days. Clinical outcomes did not differ across bilateral stenosis groups. Conclusions Following ischaemic stroke, severe ipsilateral carotid stenosis is associated with worse functional outcome at 90 days. GTN appears safe in ipsilateral or bilateral carotid stenosis, and might improve outcome in severe ipsilateral carotid stenosis.en_US
dc.description.sponsorshipBupa Foundation; Medical Research CouncilMedical Research Council UK (MRC) [G0501797]; NIHR TARDIS [10/104/24]; BHF RIGHT-2 [CS/14/4/30972]en_US
dc.description.sponsorshipENOS was funded by Bupa Foundation and the Medical Research Council (G0501797). JPA is funded by NIHR TARDIS (10/104/24) and BHF RIGHT-2 (CS/14/4/30972).en_US
dc.identifier.citationAppleton, J. P., Woodhouse, L. J., Belcher, A., Bereczki, D., Berge, E., Caso, V., Chang, H. M., Christensen, H. K., Collins, R., Gommans, J., Laska, A. C., Ntaios, G., Ozturk, S., Sare, G. M., Szatmari, S., Wang, Y., Wardlaw, J. M., Sprigg, N., Bath, P. M. (2019). It İs Safe To Use Transdermal Glyceryl Trinitrate To Lower Blood Pressure İn Patients With Acute İschaemic Stroke With Carotid Stenosis. Stroke And Vascular Neurology, 4,(1).
dc.identifier.doi10.1136/svn-2019-000232en_US
dc.identifier.endpage35en_US
dc.identifier.issn2059-8688en_US
dc.identifier.issn2059-8696en_US
dc.identifier.issue1en_US
dc.identifier.pmid31105976en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage28en_US
dc.identifier.urihttps://dx.doi.org/10.1136/svn-2019-000232
dc.identifier.urihttps://hdl.handle.net/20.500.12395/37969
dc.identifier.volume4en_US
dc.identifier.wosWOS:000490735500006en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.institutionauthorOzturk, Serefnur
dc.language.isoenen_US
dc.publisherBMJ PUBLISHING GROUPen_US
dc.relation.ispartofSTROKE AND VASCULAR NEUROLOGYen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.selcuk20240510_oaigen_US
dc.subjectacute strokeen_US
dc.subjectcarotid stenosisen_US
dc.subjectglyceryl trinitrateen_US
dc.subjectblood pressureen_US
dc.subjectsafetyen_US
dc.titleIt is safe to use transdermal glyceryl trinitrate to lower blood pressure in patients with acute ischaemic stroke with carotid stenosisen_US
dc.typeArticleen_US

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