Relationship between nitrate headache and outcome in patients with acute stroke: Results from the efficacy of nitric oxide in stroke (ENOS) trial
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Relationship between nitrate headache and outcome in patients with acute stroke : Results from the efficacy of nitric oxide in stroke (ENOS) trial. / Beishon, Lucy; Woodhouse, Lisa J.; Bereczki, Daniel; Christensen, Hanne K.; Collins, Ronan; Gommans, John; Kruuse, Christina; Ntaios, George; Ozturk, Serefnur; Phillips, Stephen; Pocock, Stuart; Szatmari, Szabolcs; Wardlaw, Joanna; Sprigg, Nikola; Bath, Philip M.
I: Stroke and Vascular Neurology, Bind 6, Nr. 2, 2021, s. 180-186.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Relationship between nitrate headache and outcome in patients with acute stroke
T2 - Results from the efficacy of nitric oxide in stroke (ENOS) trial
AU - Beishon, Lucy
AU - Woodhouse, Lisa J.
AU - Bereczki, Daniel
AU - Christensen, Hanne K.
AU - Collins, Ronan
AU - Gommans, John
AU - Kruuse, Christina
AU - Ntaios, George
AU - Ozturk, Serefnur
AU - Phillips, Stephen
AU - Pocock, Stuart
AU - Szatmari, Szabolcs
AU - Wardlaw, Joanna
AU - Sprigg, Nikola
AU - Bath, Philip M.
N1 - Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved.
PY - 2021
Y1 - 2021
N2 - Introduction Nitrate-induced headache is common and may signify responsive cerebral vasculature. We assessed the relationship between nitrate headache and outcome in patients with acute stroke. Materials and methods Patients were those randomised to glyceryl trinitrate (GTN) versus no GTN in the efficacy of nitric oxide in stroke trial. Development of headache by end of treatment (day 7), and functional outcome (modified Rankin Scale, primary outcome) at day 90, were assessed. Analyses are adjusted for baseline prognostic factors and give OR and mean difference (MD) with 95% CI. Results In 4011 patients, headache was more common in GTN than control (360, 18.0% vs 170, 8.5%; p<0.001). Nitrate-related headache was associated with: younger age, female sex, higher diastolic blood pressure, non-total anterior circulation syndrome, milder stroke and absence of dysphasia (p<0.05). Nitrate headache was not associated with improved functional outcome (OR 0.90, 95% CI 0.73 to 1.10, p=0.30) or death (day 90) (HR 0.64, 95% CI 0.40 to 1.02, p=0.062), but reduced death or deterioration (day 7) (OR 0.45, 95% CI 0.25 to 0.82), death in hospital (OR 0.44, 95% CI 0.22 to 0.88) and improved activities of daily living (Barthel index, MD 3.7, 95% CI 0.3 to 7.1) and cognition (telephone interview cognitive screen, MD 2.0, 95% CI 0.7 to 3.3) (day 90). Non-nitrate headache was not associated with death, disability or cognition. Discussion and conclusion Development of a nitrate headache by day 7 after stroke may be associated with improved activities of daily living and cognitive impairment at day 90, which was not seen with non-nitrate headache.
AB - Introduction Nitrate-induced headache is common and may signify responsive cerebral vasculature. We assessed the relationship between nitrate headache and outcome in patients with acute stroke. Materials and methods Patients were those randomised to glyceryl trinitrate (GTN) versus no GTN in the efficacy of nitric oxide in stroke trial. Development of headache by end of treatment (day 7), and functional outcome (modified Rankin Scale, primary outcome) at day 90, were assessed. Analyses are adjusted for baseline prognostic factors and give OR and mean difference (MD) with 95% CI. Results In 4011 patients, headache was more common in GTN than control (360, 18.0% vs 170, 8.5%; p<0.001). Nitrate-related headache was associated with: younger age, female sex, higher diastolic blood pressure, non-total anterior circulation syndrome, milder stroke and absence of dysphasia (p<0.05). Nitrate headache was not associated with improved functional outcome (OR 0.90, 95% CI 0.73 to 1.10, p=0.30) or death (day 90) (HR 0.64, 95% CI 0.40 to 1.02, p=0.062), but reduced death or deterioration (day 7) (OR 0.45, 95% CI 0.25 to 0.82), death in hospital (OR 0.44, 95% CI 0.22 to 0.88) and improved activities of daily living (Barthel index, MD 3.7, 95% CI 0.3 to 7.1) and cognition (telephone interview cognitive screen, MD 2.0, 95% CI 0.7 to 3.3) (day 90). Non-nitrate headache was not associated with death, disability or cognition. Discussion and conclusion Development of a nitrate headache by day 7 after stroke may be associated with improved activities of daily living and cognitive impairment at day 90, which was not seen with non-nitrate headache.
KW - blood pressure
KW - intervention
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85095819081&partnerID=8YFLogxK
U2 - 10.1136/svn-2020-000498
DO - 10.1136/svn-2020-000498
M3 - Journal article
C2 - 33154177
AN - SCOPUS:85095819081
VL - 6
SP - 180
EP - 186
JO - Stroke and Vascular Neurology
JF - Stroke and Vascular Neurology
SN - 2059-8688
IS - 2
ER -
ID: 305118646