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Transdermal glyceryl trinitrate lowers blood pressure and maintains cerebral blood flow in recent stroke.
Hypertension. 2006 Jun; 47(6):1209-15.H

Abstract

High blood pressure (BP) is common in acute stroke and is independently associated with a poor outcome. Lowering BP might improve outcome if it did not adversely affect cerebral blood flow (CBF) or cerebral perfusion pressure. We investigated the effect of glyceryl trinitrate ([GTN] an NO donor) on quantitative CBF, BP, and cerebral perfusion pressure in patients with recent stroke. Eighteen patients with recent (<5 days) ischemic (n=16) or hemorrhagic (n=2) stroke were randomly assigned (2:1) to transdermal GTN (5 mg) or control. CBF (global, hemispheric, arterial territory, and lesion, using xenon computed tomography) and BP (peripheral and central) were measured before and 1 hour after treatment with GTN. The effects of GTN on CBF and BP were adjusted for baseline measurements (ANCOVA). GTN lowered peripheral systolic BP by (mean) 23 mm Hg (95% CI, 2 to 45; P=0.03) and central systolic BP by 22 mm Hg (95% CI, 0 to 44; P=0.048). In contrast, GTN did not alter CBF (mL/min per 100 g): global -1.2 (95% CI, -6.5 to 4.2; P=0.66) and ipsilateral hemisphere -1.4 (95% CI, -7.6 to 4.9; P=0.65) or area of stroke oligemia, penumbra, or core (as defined by critical CBF limits). Contralateral CBF did not change: hemisphere 0 (95% CI, -7 to 6; P=0.96). GTN did not alter cerebral perfusion pressure or zero-filling pressure. Significant reductions in BP after transdermal GTN are not associated with changes in CBF or cerebral perfusion pressure or cerebral steal in patients with recent stroke. Trials need to assess the effect of lowering BP on functional outcome.

Authors+Show Affiliations

Willmot M
Institute of Neuroscience, University of Nottingham, Nottingham, United Kingdom.
Ghadami A
No affiliation info available
Whysall B
No affiliation info available
Clarke W
No affiliation info available
Wardlaw J
No affiliation info available
Bath PM
No affiliation info available

MeSH

AgedAged, 80 and overBlood PressureCerebrovascular CirculationDouble-Blind MethodFemaleHumansHypertensionMaleMiddle AgedNitric Oxide DonorsNitroglycerinStrokeTomography, X-Ray ComputedXenon

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16682611

Citation

Willmot, Mark, et al. "Transdermal Glyceryl Trinitrate Lowers Blood Pressure and Maintains Cerebral Blood Flow in Recent Stroke." Hypertension (Dallas, Tex. : 1979), vol. 47, no. 6, 2006, pp. 1209-15.
Willmot M, Ghadami A, Whysall B, et al. Transdermal glyceryl trinitrate lowers blood pressure and maintains cerebral blood flow in recent stroke. Hypertension. 2006;47(6):1209-15.
Willmot, M., Ghadami, A., Whysall, B., Clarke, W., Wardlaw, J., & Bath, P. M. (2006). Transdermal glyceryl trinitrate lowers blood pressure and maintains cerebral blood flow in recent stroke. Hypertension (Dallas, Tex. : 1979), 47(6), 1209-15.
Willmot M, et al. Transdermal Glyceryl Trinitrate Lowers Blood Pressure and Maintains Cerebral Blood Flow in Recent Stroke. Hypertension. 2006;47(6):1209-15. PubMed PMID: 16682611.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transdermal glyceryl trinitrate lowers blood pressure and maintains cerebral blood flow in recent stroke. AU - Willmot,Mark, AU - Ghadami,Andrew, AU - Whysall,Beverly, AU - Clarke,Wim, AU - Wardlaw,Joanna, AU - Bath,Philip M W, Y1 - 2006/05/08/ PY - 2006/5/10/pubmed PY - 2006/6/9/medline PY - 2006/5/10/entrez SP - 1209 EP - 15 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 47 IS - 6 N2 - High blood pressure (BP) is common in acute stroke and is independently associated with a poor outcome. Lowering BP might improve outcome if it did not adversely affect cerebral blood flow (CBF) or cerebral perfusion pressure. We investigated the effect of glyceryl trinitrate ([GTN] an NO donor) on quantitative CBF, BP, and cerebral perfusion pressure in patients with recent stroke. Eighteen patients with recent (<5 days) ischemic (n=16) or hemorrhagic (n=2) stroke were randomly assigned (2:1) to transdermal GTN (5 mg) or control. CBF (global, hemispheric, arterial territory, and lesion, using xenon computed tomography) and BP (peripheral and central) were measured before and 1 hour after treatment with GTN. The effects of GTN on CBF and BP were adjusted for baseline measurements (ANCOVA). GTN lowered peripheral systolic BP by (mean) 23 mm Hg (95% CI, 2 to 45; P=0.03) and central systolic BP by 22 mm Hg (95% CI, 0 to 44; P=0.048). In contrast, GTN did not alter CBF (mL/min per 100 g): global -1.2 (95% CI, -6.5 to 4.2; P=0.66) and ipsilateral hemisphere -1.4 (95% CI, -7.6 to 4.9; P=0.65) or area of stroke oligemia, penumbra, or core (as defined by critical CBF limits). Contralateral CBF did not change: hemisphere 0 (95% CI, -7 to 6; P=0.96). GTN did not alter cerebral perfusion pressure or zero-filling pressure. Significant reductions in BP after transdermal GTN are not associated with changes in CBF or cerebral perfusion pressure or cerebral steal in patients with recent stroke. Trials need to assess the effect of lowering BP on functional outcome. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/16682611/Transdermal_glyceryl_trinitrate_lowers_blood_pressure_and_maintains_cerebral_blood_flow_in_recent_stroke_ DB - PRIME DP - Unbound Medicine ER -