Effect of Glyceryl Trinitrate on Hemodynamics in Acute Stroke: Data from the ENOS Trial
Date
2019Language
en
Sujet
Résumé
Background 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 between-visit systolic BP variability. Agents that lower BP variability in acute stroke require further study. © 2019 International Anesthesia Research Society.
Collections
Related items
Showing items related by title, author, creator and subject.
-
Epidemiology of Hypertension among Patients on Peritoneal Dialysis Using Standardized Office and Ambulatory Blood Pressure Recordings
Vareta G., Georgianos P.I., Vaios V., Sgouropoulou V., Roumeliotis S., Georgoulidou A., Dounousi E., Eleftheriadis T., Papagianni A., Balaskas E.V., Zebekakis P.E., Liakopoulos V. (2022)Introduction: Prior studies conducted in peritoneal dialysis (PD) patients in the late 1990s provided considerably variable estimates of the prevalence and control of hypertension. The present study aimed to investigate ... -
Age dependence of brachial cuff-based ambulatory PWV in end-stage kidney disease patients undergoing long-term peritoneal dialysis
Vaios V., Georgianos P.I., Vareta G., Divanis D., Dounousi E., Eleftheriadis T., Papagianni A., Zebekakis P.E., Liakopoulos V. (2022)Background: The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic ... -
Effect of liraglutide on ambulatory blood pressure in patients with hypertension and type 2 diabetes: A randomized, double-blind, placebo-controlled trial
Liakos A., Lambadiari V., Bargiota A., Kitsios K., Avramidis I., Kotsa K., Gerou S., Boura P., Tentolouris N., Dimitriadis G., Tsapas A. (2019)Aims: To assess the effect of liraglutide on 24-hour ambulatory blood pressure and heart rate in patients with hypertension (pre- and stage 1 hypertension) and inadequately controlled Type 2 diabetes (glycated haemoglobin ...