Clinical trial sheds new light on BP management during stroke treatment

Through a new clinical trial, scientists have found the efficiency of standard procedure for managing blood pressure in stroke patients.

Washington: Through a new clinical trial, scientists have found the efficiency of standard procedure for managing blood pressure in stroke patients.

The two-part ENOS trial (Efficacy of Nitric Oxide in Stroke,) was carried out at The University of Nottingham in collaboration with 23 countries to try to solve two major conundrums faced by doctors when treating people who have suffered a stroke - should blood pressure be lowered using medicated skin patches, and should existing blood pressure medication be stopped or continued after a stroke?

The trial involved 4,011 patients with acute stroke, both ischaemic (blood clot) and haemorrhagic (bleeding). Patients were randomly assigned to receive a glyceryl trinitrate 5mg skin patch (often used in angina patients) or no patch for 7 days. Patients who were already on medication for high blood pressure before their stroke were also randomly assigned to either continue or stop this for 7 days after the stroke.

Professor Philip Bath, who led the trial, said that they found that in patients with acute stroke and high blood pressure, treatment with glyceryl trinitrate patches had acceptable safety but did not improve functional outcome. But there seemed to be benefit in patients who were treated very early, within 6 hours of the onset of symptoms.

According to the results, there was no evidence to support the policy of continuing pre-stroke blood pressure -lowering medication in the acute phase of stroke. An adverse effect in the group continuing medication was pneumonia in patients who had difficulty swallowing, perhaps due to inhalation of the medication into the lungs. Furthermore, discharge home, disability and cognition were all less favourable in those who were allocated to continue BP treatment immediately.

Professor Bath added that the results suggest that antihypertensive treatment should be continued once a patient who had suffered a stroke was stable and was able to swallow medications safely. But there appeared no urgency to restart treatment in the first week.

The results are due to be published in The Lancet.

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