Effect of glyceryl trinitrate on hemodynamics in acute stroke data from the ENOS trial

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dc.contributor.authorAppleton, Jason P.
dc.contributor.authorWoodhouse, Lisa J.
dc.contributor.authorBereczki, Daniel.
dc.contributor.authorBerge, Eivind.
dc.contributor.authorChristensen, Hanne K.
dc.contributor.authorCollins, Ronan.
dc.contributor.authorGommans, John.
dc.contributor.authorNtaios, George.
dc.contributor.authorOzturk, Serefnur.
dc.contributor.authorSzatmari, Szabolcs.
dc.contributor.authorWardlaw, Joanna M.
dc.contributor.authorSprigg, Nikola.
dc.contributor.authorRothwell, Peter M.
dc.contributor.authorBath, Philip M.
dc.date.accessioned2020-03-26T20:13:37Z
dc.date.available2020-03-26T20:13:37Z
dc.date.issued2019
dc.departmentSelçuk Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümen_US
dc.description.abstractBackground and Purpose-Increased blood pressure (BP), heart rate, and their derivatives (variability, pulse pressure, rate-pressure product) are associated with poor clinical outcome in acute stroke. We assessed the effects of glyceryl trinitrate (GTN) on hemodynamic parameters and these on outcome in participants in the ENOS trial (Efficacy of Nitric Oxide in Stroke). Methods-Four thousand and eleven patients with acute stroke and raised BP were randomized within 48 hours of onset to transdermal GTN or no GTN for 7 days. Peripheral hemodynamics were measured at baseline (3 measures) and daily (2 measures) during treatment. Between-visit BP variability over days 1 to 7 (as SD) was assessed in quintiles. Functional outcome was assessed as modified Rankin Scale and cognition as telephone mini-mental state examination at day 90. Analyses were adjusted for baseline prognostic variables. Data are mean difference or odds ratios with 95% CI. Results-Increased baseline BP (diastolic, variability), heart rate, and rate-pressure product were each associated with unfavorable functional outcome at day 90. Increased between-visit systolic BP variability was associated with an unfavourable shift in modified Rankin Scale (highest quintile adjusted odds ratio, 1.65; 95% CI, 1.37-1.99), worse cognitive scores (telephone mini-mental state examination: highest quintile adjusted mean difference, -2.03; 95% CI, -2.84 to -1.22), and increased odds of death at day 90 (highest quintile adjusted odds ratio, 1.57; 95% CI, 1.12-2.19). GTN lowered BP and rate-pressure product and increased heart rate at day 1 and reduced between-visit systolic BP variability. Conclusions-Increased between-visit BP variability was associated with poor functional and cognitive outcomes and increased death 90 days after acute stroke. In addition to lowering BP and rate-pressure product, GTN reduced betweenvisit systolic BP variability. Agents that lower BP variability in acute stroke require further study.en_US
dc.description.sponsorshipBritish United Provident Association UK Foundation; National Institute for Health Research TARDIS [10/104/24]; British Heart Foundation RIGHT-2 (Rapid Intervention With Glyceryl Trinitrate in Hypertensive Stroke Trial 2) [CS/14/4/30972]; Medical Research CouncilMedical Research Council UK (MRC) [G0501797]en_US
dc.description.sponsorshipENOS (Efficacy of Nitric Oxide in Stroke) was funded by the British United Provident Association UK Foundation and Medical Research Council (G0501797). J.P. Appleton is funded by National Institute for Health Research TARDIS (10/104/24) trial (Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke) and British Heart Foundation RIGHT-2 (Rapid Intervention With Glyceryl Trinitrate in Hypertensive Stroke Trial 2; CS/14/4/30972).en_US
dc.identifier.citationAppleton, J.P., Woodhouse, L.J., Bereczki, D., Berge, E., Christensen, H. K., Collins, R., Gommans, J., Ntaios, G., Ozturk, S., Szatmari, S., Wardlaw, J. M., Sprigg, N., Rothwell, P. M., Bath, P. M. (2019). Effect of Glyceryl Trinitrate on Hemodynamics in Acute Stroke. Stroke, 50(2), 405-412.
dc.identifier.doi10.1161/STROKEAHA.118.023190en_US
dc.identifier.endpage412en_US
dc.identifier.issn0039-2499en_US
dc.identifier.issn1524-4628en_US
dc.identifier.issue2en_US
dc.identifier.pmid30626285en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage405en_US
dc.identifier.urihttps://dx.doi.org/10.1161/STROKEAHA.118.023190
dc.identifier.urihttps://hdl.handle.net/20.500.12395/37731
dc.identifier.volume50en_US
dc.identifier.wosWOS:000469346800032en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.institutionauthorOzturk, Serefnur.
dc.language.isoenen_US
dc.publisherLIPPINCOTT WILLIAMS & WILKINSen_US
dc.relation.ispartofSTROKEen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.selcuk20240510_oaigen_US
dc.subjectblood pressureen_US
dc.subjectglyceryl trinitrateen_US
dc.subjectheart rateen_US
dc.subjecthemodynamicsen_US
dc.subjecthemorrhageen_US
dc.titleEffect of glyceryl trinitrate on hemodynamics in acute stroke data from the ENOS trialen_US
dc.typeArticleen_US

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