Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial

Kailash Krishnan; Polly Scutt; Lisa Woodhouse; Alessandro Adami; Jennifer L Becker; Lesley A Cala; Ana M Casado; Christopher Chen; Robert A Dineen; John Gommans; Panos Koumellis; Hanna Belcik Christensen; Ronan Collins; Anna Czlonkowska; Kennedy R Lees; George Ntaios; Serefnur Ozturk; Stephen J Phillips; Nikola Sprigg; Szabolcs Szatmari; Joanna M Wardlaw; Philip M W Bath; ENOS Investigators

doi:10.1016/j.jstrokecerebrovasdis.2016.01.010

Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial

Kailash Krishnan, Polly Scutt, Lisa Woodhouse, Alessandro Adami, Jennifer L Becker, Lesley A Cala, Ana M Casado, Christopher Chen, Robert A Dineen, John Gommans, Panos Koumellis, Hanna Belcik Christensen, Ronan Collins, Anna Czlonkowska, Kennedy R Lees, George Ntaios, Serefnur Ozturk, Stephen J Phillips, Nikola Sprigg, Szabolcs SzatmariJoanna M Wardlaw, Philip M W Bath, ENOS Investigators

7 Citationer (Scopus)

Abstract

Background and purpose More than 50% of patients with acute intracerebral hemorrhage (ICH) are taking antihypertensive drugs before ictus. Although antihypertensive therapy should be given long term for secondary prevention, whether to continue or stop such treatment during the acute phase of ICH remains unclear, a question that was addressed in the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Methods ENOS was an international multicenter, prospective, randomized, blinded endpoint trial. Among 629 patients with ICH and systolic blood pressure between 140 and 220 mmHg, 246 patients who were taking antihypertensive drugs were assigned to continue (n = 119) or to stop (n = 127) taking drugs temporarily for 7 days. The primary outcome was the modified Rankin Score at 90 days. Secondary outcomes included death, length of stay in hospital, discharge destination, activities of daily living, mood, cognition, and quality of life. Results Blood pressure level (baseline 171/92 mmHg) fell in both groups but was significantly lower at 7 days in those patients assigned to continue antihypertensive drugs (difference 9.4/3.5 mmHg, P <.01). At 90 days, the primary outcome did not differ between the groups; the adjusted common odds ratio (OR) for worse outcome with continue versus stop drugs was.92 (95% confidence interval,.45-1.89; P =.83). There was no difference between the treatment groups for any secondary outcome measure, or rates of death or serious adverse events. Conclusions Among patients with acute ICH, immediate continuation of antihypertensive drugs during the first week did not reduce death or major disability in comparison to stopping treatment temporarily.

Originalsprog	Engelsk
Tidsskrift	Journal of Stroke & Cerebrovascular Diseases
Vol/bind	25
Udgave nummer	5
Sider (fra-til)	1017-26
Antal sider	10
ISSN	1052-3057
DOI	https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.01.010
Status	Udgivet - 1 maj 2016

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10.1016/j.jstrokecerebrovasdis.2016.01.010

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Krishnan, K., Scutt, P., Woodhouse, L., Adami, A., Becker, J. L., Cala, L. A., Casado, A. M., Chen, C., Dineen, R. A., Gommans, J., Koumellis, P., Christensen, H. B., Collins, R., Czlonkowska, A., Lees, K. R., Ntaios, G., Ozturk, S., Phillips, S. J., Sprigg, N., ... ENOS Investigators (2016). Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial. Journal of Stroke & Cerebrovascular Diseases, 25(5), 1017-26. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.01.010

Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial. / Krishnan, Kailash; Scutt, Polly; Woodhouse, Lisa et al.
I: Journal of Stroke & Cerebrovascular Diseases, Bind 25, Nr. 5, 01.05.2016, s. 1017-26.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Krishnan, K, Scutt, P, Woodhouse, L, Adami, A, Becker, JL, Cala, LA, Casado, AM, Chen, C, Dineen, RA, Gommans, J, Koumellis, P, Christensen, HB, Collins, R, Czlonkowska, A, Lees, KR, Ntaios, G, Ozturk, S, Phillips, SJ, Sprigg, N, Szatmari, S, Wardlaw, JM, Bath, PMW & ENOS Investigators 2016, 'Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial', Journal of Stroke & Cerebrovascular Diseases, bind 25, nr. 5, s. 1017-26. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.01.010

@article{63145bd8f04b48278acaf9555f2497ea,

title = "Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial",

abstract = "Background and purpose More than 50% of patients with acute intracerebral hemorrhage (ICH) are taking antihypertensive drugs before ictus. Although antihypertensive therapy should be given long term for secondary prevention, whether to continue or stop such treatment during the acute phase of ICH remains unclear, a question that was addressed in the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Methods ENOS was an international multicenter, prospective, randomized, blinded endpoint trial. Among 629 patients with ICH and systolic blood pressure between 140 and 220 mmHg, 246 patients who were taking antihypertensive drugs were assigned to continue (n = 119) or to stop (n = 127) taking drugs temporarily for 7 days. The primary outcome was the modified Rankin Score at 90 days. Secondary outcomes included death, length of stay in hospital, discharge destination, activities of daily living, mood, cognition, and quality of life. Results Blood pressure level (baseline 171/92 mmHg) fell in both groups but was significantly lower at 7 days in those patients assigned to continue antihypertensive drugs (difference 9.4/3.5 mmHg, P <.01). At 90 days, the primary outcome did not differ between the groups; the adjusted common odds ratio (OR) for worse outcome with continue versus stop drugs was.92 (95% confidence interval,.45-1.89; P =.83). There was no difference between the treatment groups for any secondary outcome measure, or rates of death or serious adverse events. Conclusions Among patients with acute ICH, immediate continuation of antihypertensive drugs during the first week did not reduce death or major disability in comparison to stopping treatment temporarily.",

keywords = "Aged, Aged, 80 and over, Antihypertensive Agents, Blood Pressure, Disability Evaluation, Drug Administration Schedule, Female, Humans, Hypertension, Intracranial Hemorrhage, Hypertensive, Linear Models, Logistic Models, Male, Middle Aged, Multivariate Analysis, Nitric Oxide Donors, Nitroglycerin, Odds Ratio, Proportional Hazards Models, Prospective Studies, Risk Factors, Stroke, Time Factors, Treatment Outcome, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial",

author = "Kailash Krishnan and Polly Scutt and Lisa Woodhouse and Alessandro Adami and Becker, {Jennifer L} and Cala, {Lesley A} and Casado, {Ana M} and Christopher Chen and Dineen, {Robert A} and John Gommans and Panos Koumellis and Christensen, {Hanna Belcik} and Ronan Collins and Anna Czlonkowska and Lees, {Kennedy R} and George Ntaios and Serefnur Ozturk and Phillips, {Stephen J} and Nikola Sprigg and Szabolcs Szatmari and Wardlaw, {Joanna M} and Bath, {Philip M W} and {ENOS Investigators}",

year = "2016",

month = may,

day = "1",

doi = "10.1016/j.jstrokecerebrovasdis.2016.01.010",

language = "English",

volume = "25",

pages = "1017--26",

journal = "Journal of Stroke & Cerebrovascular Diseases",

issn = "1052-3057",

publisher = "W.B.Saunders Co.",

number = "5",

}

TY - JOUR

T1 - Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage

T2 - A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial

AU - Krishnan, Kailash

AU - Scutt, Polly

AU - Woodhouse, Lisa

AU - Adami, Alessandro

AU - Becker, Jennifer L

AU - Cala, Lesley A

AU - Casado, Ana M

AU - Chen, Christopher

AU - Dineen, Robert A

AU - Gommans, John

AU - Koumellis, Panos

AU - Christensen, Hanna Belcik

AU - Collins, Ronan

AU - Czlonkowska, Anna

AU - Lees, Kennedy R

AU - Ntaios, George

AU - Ozturk, Serefnur

AU - Phillips, Stephen J

AU - Sprigg, Nikola

AU - Szatmari, Szabolcs

AU - Wardlaw, Joanna M

AU - Bath, Philip M W

AU - ENOS Investigators

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background and purpose More than 50% of patients with acute intracerebral hemorrhage (ICH) are taking antihypertensive drugs before ictus. Although antihypertensive therapy should be given long term for secondary prevention, whether to continue or stop such treatment during the acute phase of ICH remains unclear, a question that was addressed in the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Methods ENOS was an international multicenter, prospective, randomized, blinded endpoint trial. Among 629 patients with ICH and systolic blood pressure between 140 and 220 mmHg, 246 patients who were taking antihypertensive drugs were assigned to continue (n = 119) or to stop (n = 127) taking drugs temporarily for 7 days. The primary outcome was the modified Rankin Score at 90 days. Secondary outcomes included death, length of stay in hospital, discharge destination, activities of daily living, mood, cognition, and quality of life. Results Blood pressure level (baseline 171/92 mmHg) fell in both groups but was significantly lower at 7 days in those patients assigned to continue antihypertensive drugs (difference 9.4/3.5 mmHg, P <.01). At 90 days, the primary outcome did not differ between the groups; the adjusted common odds ratio (OR) for worse outcome with continue versus stop drugs was.92 (95% confidence interval,.45-1.89; P =.83). There was no difference between the treatment groups for any secondary outcome measure, or rates of death or serious adverse events. Conclusions Among patients with acute ICH, immediate continuation of antihypertensive drugs during the first week did not reduce death or major disability in comparison to stopping treatment temporarily.

AB - Background and purpose More than 50% of patients with acute intracerebral hemorrhage (ICH) are taking antihypertensive drugs before ictus. Although antihypertensive therapy should be given long term for secondary prevention, whether to continue or stop such treatment during the acute phase of ICH remains unclear, a question that was addressed in the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Methods ENOS was an international multicenter, prospective, randomized, blinded endpoint trial. Among 629 patients with ICH and systolic blood pressure between 140 and 220 mmHg, 246 patients who were taking antihypertensive drugs were assigned to continue (n = 119) or to stop (n = 127) taking drugs temporarily for 7 days. The primary outcome was the modified Rankin Score at 90 days. Secondary outcomes included death, length of stay in hospital, discharge destination, activities of daily living, mood, cognition, and quality of life. Results Blood pressure level (baseline 171/92 mmHg) fell in both groups but was significantly lower at 7 days in those patients assigned to continue antihypertensive drugs (difference 9.4/3.5 mmHg, P <.01). At 90 days, the primary outcome did not differ between the groups; the adjusted common odds ratio (OR) for worse outcome with continue versus stop drugs was.92 (95% confidence interval,.45-1.89; P =.83). There was no difference between the treatment groups for any secondary outcome measure, or rates of death or serious adverse events. Conclusions Among patients with acute ICH, immediate continuation of antihypertensive drugs during the first week did not reduce death or major disability in comparison to stopping treatment temporarily.

KW - Aged

KW - Aged, 80 and over

KW - Antihypertensive Agents

KW - Blood Pressure

KW - Disability Evaluation

KW - Drug Administration Schedule

KW - Female

KW - Humans

KW - Hypertension

KW - Intracranial Hemorrhage, Hypertensive

KW - Linear Models

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Nitric Oxide Donors

KW - Nitroglycerin

KW - Odds Ratio

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Risk Factors

KW - Stroke

KW - Time Factors

KW - Treatment Outcome

KW - Comparative Study

KW - Journal Article

KW - Multicenter Study

KW - Randomized Controlled Trial

U2 - 10.1016/j.jstrokecerebrovasdis.2016.01.010

DO - 10.1016/j.jstrokecerebrovasdis.2016.01.010

M3 - Journal article

C2 - 26853137

SN - 1052-3057

VL - 25

SP - 1017

EP - 1026

JO - Journal of Stroke & Cerebrovascular Diseases

JF - Journal of Stroke & Cerebrovascular Diseases

IS - 5

ER -

Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial

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