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Impact of hydration status on haemodynamics, effects of acute blood pressure‐lowering treatment, and prognosis after stroke

AIMS: Although high blood pressure (BP) is common in acute stroke and associated with poor outcome, the Efficacy of Nitric Oxide in Stroke (ENOS) trial showed no beneficial effect of antihypertensive treatment in this situation. Antihypertensive agents have accentuated effects in dehydrated patients...

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Autores principales: Billington, Charlotte K., Appleton, Jason P., Berge, Eivind, Sprigg, Nikola, Glover, Mark, Bath, Philip M. W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256053/
https://www.ncbi.nlm.nih.gov/pubmed/30194849
http://dx.doi.org/10.1111/bcp.13761
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author Billington, Charlotte K.
Appleton, Jason P.
Berge, Eivind
Sprigg, Nikola
Glover, Mark
Bath, Philip M. W.
author_facet Billington, Charlotte K.
Appleton, Jason P.
Berge, Eivind
Sprigg, Nikola
Glover, Mark
Bath, Philip M. W.
author_sort Billington, Charlotte K.
collection PubMed
description AIMS: Although high blood pressure (BP) is common in acute stroke and associated with poor outcome, the Efficacy of Nitric Oxide in Stroke (ENOS) trial showed no beneficial effect of antihypertensive treatment in this situation. Antihypertensive agents have accentuated effects in dehydrated patients. We assessed the impact of dehydration on haemodynamics, the effects of antihypertensive treatment, and prognosis in the ENOS trial. METHODS: ENOS randomized 4011 patients with acute stroke and raised systolic BP to a glyceryl trinitrate (GTN) patch or no GTN patch, and to continue or to stop existing antihypertensive treatment within 48 h of onset. The primary outcome was functional outcome (modified Rankin Scale, mRS) at day 90. Blood markers of dehydration at baseline were collected at two sites (n = 310) and their relationship with haemodynamics and outcome was assessed. RESULTS: There were no significant associations between dehydration markers and fall in blood pressure from baseline to day 1, and no significant interaction with allocated treatment. Overall, increasing urea was associated with an unfavourable shift in mRS [odds ratio 3.43, 95% confidence interval (CI) 1.42, 8.32; P = 0.006] and increased risk of death at day 90 (hazard ratio 4.55, 95% CI 1.51, 13.66; P = 0.007). CONCLUSIONS: Blood pressure‐lowering treatment was safe in dehydrated patients, with no precipitous changes in BP, thus supporting its use in acute stroke prior to blood markers of dehydration becoming available. Increased baseline urea was associated with poor prognosis after stroke.
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spelling pubmed-62560532018-12-03 Impact of hydration status on haemodynamics, effects of acute blood pressure‐lowering treatment, and prognosis after stroke Billington, Charlotte K. Appleton, Jason P. Berge, Eivind Sprigg, Nikola Glover, Mark Bath, Philip M. W. Br J Clin Pharmacol Original Articles AIMS: Although high blood pressure (BP) is common in acute stroke and associated with poor outcome, the Efficacy of Nitric Oxide in Stroke (ENOS) trial showed no beneficial effect of antihypertensive treatment in this situation. Antihypertensive agents have accentuated effects in dehydrated patients. We assessed the impact of dehydration on haemodynamics, the effects of antihypertensive treatment, and prognosis in the ENOS trial. METHODS: ENOS randomized 4011 patients with acute stroke and raised systolic BP to a glyceryl trinitrate (GTN) patch or no GTN patch, and to continue or to stop existing antihypertensive treatment within 48 h of onset. The primary outcome was functional outcome (modified Rankin Scale, mRS) at day 90. Blood markers of dehydration at baseline were collected at two sites (n = 310) and their relationship with haemodynamics and outcome was assessed. RESULTS: There were no significant associations between dehydration markers and fall in blood pressure from baseline to day 1, and no significant interaction with allocated treatment. Overall, increasing urea was associated with an unfavourable shift in mRS [odds ratio 3.43, 95% confidence interval (CI) 1.42, 8.32; P = 0.006] and increased risk of death at day 90 (hazard ratio 4.55, 95% CI 1.51, 13.66; P = 0.007). CONCLUSIONS: Blood pressure‐lowering treatment was safe in dehydrated patients, with no precipitous changes in BP, thus supporting its use in acute stroke prior to blood markers of dehydration becoming available. Increased baseline urea was associated with poor prognosis after stroke. John Wiley and Sons Inc. 2018-10-10 2018-12 /pmc/articles/PMC6256053/ /pubmed/30194849 http://dx.doi.org/10.1111/bcp.13761 Text en © 2018 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Billington, Charlotte K.
Appleton, Jason P.
Berge, Eivind
Sprigg, Nikola
Glover, Mark
Bath, Philip M. W.
Impact of hydration status on haemodynamics, effects of acute blood pressure‐lowering treatment, and prognosis after stroke
title Impact of hydration status on haemodynamics, effects of acute blood pressure‐lowering treatment, and prognosis after stroke
title_full Impact of hydration status on haemodynamics, effects of acute blood pressure‐lowering treatment, and prognosis after stroke
title_fullStr Impact of hydration status on haemodynamics, effects of acute blood pressure‐lowering treatment, and prognosis after stroke
title_full_unstemmed Impact of hydration status on haemodynamics, effects of acute blood pressure‐lowering treatment, and prognosis after stroke
title_short Impact of hydration status on haemodynamics, effects of acute blood pressure‐lowering treatment, and prognosis after stroke
title_sort impact of hydration status on haemodynamics, effects of acute blood pressure‐lowering treatment, and prognosis after stroke
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256053/
https://www.ncbi.nlm.nih.gov/pubmed/30194849
http://dx.doi.org/10.1111/bcp.13761
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