Woodhouse Lisa J, Appleton Jason P, Scutt Polly, Everton Lisa, Wilkinson Gwenllian, Caso Valeria, Czlonkowska Anna, Gommans John, Krishnan Kailash, Laska Ann C, Ntaios George, Ozturk Serefnur, Phillips Stephen, Pocock Stuart, Prasad Kameshwar, Szatmari Szabolcs, Wardlaw Joanna M, Sprigg Nikola, Bath Philip M
Stroke Trials Unit, Mental Health & Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, South Block D floor, Nottingham NG7 2UH UK.
Stroke, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2GW, UK.
EClinicalMedicine. 2022 Jan 24;44:101274. doi: 10.1016/j.eclinm.2022.101274. eCollection 2022 Feb.
It is not known whether to continue or temporarily stop existing antihypertensive drugs in patients with acute stroke.
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.
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 (<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.
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.
急性卒中患者是否应继续使用或暂时停用现有的抗高血压药物尚不清楚。
我们对纳入一氧化氮治疗卒中疗效（ENOS）试验的患者进行了一项前瞻性亚组分析，这些患者在卒中发作后12小时内被随机分为继续或停用先前的抗高血压治疗组。主要结局是功能转归，由对治疗分配不知情的观察者在90天时用改良Rankin量表进行评估，并采用有序逻辑回归分析。
在2001年至2014年纳入ENOS的4011例患者中，2097例患者被随机分为继续或停用先前的抗高血压治疗组，384例（18.3%，继续治疗组185例，停药组199例）在发病后12小时内入组：平均（标准差）年龄71.8（11.8）岁，女性193例（50.3%），缺血性卒中342例（89.1%），完全前循环综合征114例（29.7%）。与停药相比，发病后12小时内继续治疗在7天时血压降低15.5/9.6 mmHg（<0.001/<0.001），到90天时改良Rankin量表转归变差，校正后的共同比值比（OR）为1.46（95%CI 1.01 - 2.11），并且与90天时死亡率增加相关（风险比2.17，95%CI 1.24 - 3.79）。继续治疗的其他结局（残疾 - Barthel指数、生活质量 - EQ视觉模拟量表、认知 - 电话简易精神状态检查、情绪 - Zung抑郁量表）也较差。
在这项对大型ENOS试验预先设定的亚组分析中，在以缺血性卒中为主的人群中，卒中发作后12小时内继续先前的抗高血压治疗不安全，功能转归、残疾、认知、情绪、生活质量更差且死亡率增加。期待未来在血管内血栓切除术背景下评估继续或停用先前抗高血压药物的研究。
