Abstract
AimsAlthough 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.MethodsENOS 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.ResultsThere 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).ConclusionsBlood 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.
Highlights
High blood pressure (BP) is common in acute stroke and associated independently with a poor outcome in both ischaemic stroke and intracerebral haemorrhage [1]
Dehydration has been associated with poor clinical outcomes following acute stroke [10,11,12], and adequate hydration after stroke is recommended in clinical guidelines [8]
Clinical characteristics were well balanced, and blood markers of dehydration did not differ between randomized groups (GTN vs. no glyceryl trinitrate (GTN), or continue vs. stop prestroke antihypertensive agents), except for raised haematocrit (Table 1)
Summary
High blood pressure (BP) is common in acute stroke and associated independently with a poor outcome in both ischaemic stroke and intracerebral haemorrhage [1]. Lowering elevated BP is recommended in acute intracerebral haemorrhage [2], and is safe in ischaemic stroke [3, 4]. Reduced circulating volume is common in stroke, especially if admission to hospital is delayed, thereby allowing dehydration to develop. Hypovolaemia may reduce cerebral perfusion and increase the infarct core in ischaemic stroke [6] and the perihaematomal ischaemia in intracerebral haemorrhage [7]. Dehydration has been associated with poor clinical outcomes following acute stroke [10,11,12], and adequate hydration after stroke is recommended in clinical guidelines [8]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call