Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomised controlled trial

Although transdermal glyceryl trinitrate started within 48 h of stroke onset lowered blood pressure and had acceptable safety, it did not improve functional outcome at 90 days compared with no GTN in 4011 patients with acute stroke and high blood pressure (mean 167/90mmHg).

Based on their results, the study authors concluded that there is no perceived benefit for lowering of blood pressure with glyceryl trinitrate in patients with acute stroke and raised blood pressure.

 

They note that it seems reasonable to withhold blood pressure-lowering drugs until patients with an acute stroke are medically and neurologically stable, and have suitable oral or enteral access to allow safe drug reintroduction. However, blood pressure control is important to reduce the risk of subsequent vascular events therefore antihypertensives will need to be restarted.