TY - JOUR
T1 - Effect of continuing versus stopping pre-stroke antihypertensive agents within 12 h on outcome after stroke
T2 - A subgroup analysis of the efficacy of nitric oxide in stroke (ENOS) trial
AU - Woodhouse, Lisa J.
AU - Appleton, Jason P.
AU - Scutt, Polly
AU - Everton, Lisa
AU - Wilkinson, Gwenllian
AU - Caso, Valeria
AU - Czlonkowska, Anna
AU - Gommans, John
AU - Krishnan, Kailash
AU - Laska, Ann C.
AU - Ntaios, George
AU - Ozturk, Serefnur
AU - Phillips, Stephen
AU - Pocock, Stuart
AU - Prasad, Kameshwar
AU - Szatmari, Szabolcs
AU - Wardlaw, Joanna M.
AU - Sprigg, Nikola
AU - Bath, Philip M.
N1 - Funding Information:
JPA was supported in part by National Institute of Health Research (NIHR) TARDIS (10/104/24) and British Heart Foundation RIGHT-2 (CS/14/4/30972) and is supported by a NIHR Health and Care Research Scholarship. JMW was supported, in part, by the Scottish Funding Council through the SINAPSE Collaboration and the UK Dementia Research Institute which receives funding from DRI Ltd, funded by the UK Medical Research Council, Alzheimer's Society and Alzheimer's Research UK. PMB is Stroke Association Professor of Stroke Medicine and a NIHR Senior Investigator. All other authors report no declarations.
Funding Information:
ENOS was funded by the UK Medical Research Council (G0501797), and Bupa, and supported by the Stroke Association .
Publisher Copyright:
© 2022 The Authors
PY - 2022/2
Y1 - 2022/2
N2 - Background: It is not known whether to continue or temporarily stop existing antihypertensive drugs in patients with acute stroke. Methods: We performed a prospective subgroup analysis of patients enrolled into the Efficacy of Nitric Oxide in Stroke (ENOS) trial who were randomised to continue vs stop prior antihypertensive therapy within 12 h of stroke onset. The primary outcome was functional outcome, assessed with the modified Rankin Scale at 90 days by observers blinded to treatment assignment, and analysed with ordinal logistic regression. Findings: Of 4011 patients recruited into ENOS from 2001 to 2014, 2097 patients were randomised to continue vs stop prior antihypertensive treatment, and 384 (18.3%, continue 185, stop 199) were enrolled within 12 h of ictus: mean (SD) age 71.8 (11.8) years, female 193 (50.3%), ischaemic stroke 342 (89.1%) and total anterior circulation syndrome 114 (29.7%). As compared with stopping, continuing treatment within 12 h of onset lowered blood pressure by 15.5/9.6 mmHg (p<0.001/<0.001) by 7 days, shifted the modified Rankin Scale to a worse outcome by day 90, adjusted common odds ratio (OR) 1.46 (95% CI 1.01–2.11), and was associated with an increased death rate by day 90 (hazard ratio 2.17, 95% CI 1.24–3.79). Other outcomes (disability - Barthel Index, quality of life - EQ-visual analogue scale, cognition - telephone mini-mental state examination, and mood - Zung depression scale) were also worse with continuing treatment. Interpretation: In this pre-specified subgroup analysis of the large ENOS trial, continuing prior antihypertensive therapy within 12 h of stroke onset in a predominantly ischaemic stroke population was unsafe with worse functional outcome, disability, cognition, mood, quality of life and increased death. Future studies assessing continuing or stopping prior antihypertensives in the context of thrombectomy are awaited.
AB - Background: It is not known whether to continue or temporarily stop existing antihypertensive drugs in patients with acute stroke. Methods: We performed a prospective subgroup analysis of patients enrolled into the Efficacy of Nitric Oxide in Stroke (ENOS) trial who were randomised to continue vs stop prior antihypertensive therapy within 12 h of stroke onset. The primary outcome was functional outcome, assessed with the modified Rankin Scale at 90 days by observers blinded to treatment assignment, and analysed with ordinal logistic regression. Findings: Of 4011 patients recruited into ENOS from 2001 to 2014, 2097 patients were randomised to continue vs stop prior antihypertensive treatment, and 384 (18.3%, continue 185, stop 199) were enrolled within 12 h of ictus: mean (SD) age 71.8 (11.8) years, female 193 (50.3%), ischaemic stroke 342 (89.1%) and total anterior circulation syndrome 114 (29.7%). As compared with stopping, continuing treatment within 12 h of onset lowered blood pressure by 15.5/9.6 mmHg (p<0.001/<0.001) by 7 days, shifted the modified Rankin Scale to a worse outcome by day 90, adjusted common odds ratio (OR) 1.46 (95% CI 1.01–2.11), and was associated with an increased death rate by day 90 (hazard ratio 2.17, 95% CI 1.24–3.79). Other outcomes (disability - Barthel Index, quality of life - EQ-visual analogue scale, cognition - telephone mini-mental state examination, and mood - Zung depression scale) were also worse with continuing treatment. Interpretation: In this pre-specified subgroup analysis of the large ENOS trial, continuing prior antihypertensive therapy within 12 h of stroke onset in a predominantly ischaemic stroke population was unsafe with worse functional outcome, disability, cognition, mood, quality of life and increased death. Future studies assessing continuing or stopping prior antihypertensives in the context of thrombectomy are awaited.
U2 - 10.1016/j.eclinm.2022.101274
DO - 10.1016/j.eclinm.2022.101274
M3 - Article
C2 - 35112073
VL - 44
JO - EClinicalMedicine
JF - EClinicalMedicine
SN - 2589-5370
M1 - 101274
ER -