title: Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial.
abstract: OBJECTIVE
  More than 50% of patients with acute intracerebral hemorrhage (ICH) are taking antihypertensive drugs before ictus. Although antihypertensive therapy should be given long term for secondary prevention, whether to continue or stop such treatment during the acute phase of ICH remains unclear, a question that was addressed in the Efficacy of Nitric Oxide in Stroke (ENOS) trial.
  
  
  METHODS
  ENOS was an international multicenter, prospective, randomized, blinded endpoint trial. Among 629 patients with ICH and systolic blood pressure between 140 and 220 mmHg, 246 patients who were taking antihypertensive drugs were assigned to continue (n = 119) or to stop (n = 127) taking drugs temporarily for 7 days. The primary outcome was the modified Rankin Score at 90 days. Secondary outcomes included death, length of stay in hospital, discharge destination, activities of daily living, mood, cognition, and quality of life.
  
  
  RESULTS
  Blood pressure level (baseline 171/92 mmHg) fell in both groups but was significantly lower at 7 days in those patients assigned to continue antihypertensive drugs (difference 9.4/3.5 mmHg, P < .01). At 90 days, the primary outcome did not differ between the groups; the adjusted common odds ratio (OR) for worse outcome with continue versus stop drugs was .92 (95% confidence interval, .45-1.89; P = .83). There was no difference between the treatment groups for any secondary outcome measure, or rates of death or serious adverse events.
  
  
  CONCLUSIONS
  Among patients with acute ICH, immediate continuation of antihypertensive drugs during the first week did not reduce death or major disability in comparison to stopping treatment temporarily.
authors: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
authors: Kailash
authors: K
authors: Krishnan
authors: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
authors: Polly
authors: P
authors: Scutt
authors: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
authors: Lisa
authors: L
authors: Woodhouse
authors: Stroke Centre, Ospedale Sacro Cuore Via Sempreboni, Verona, Italy.
authors: Alessandro
authors: A
authors: Adami
authors: Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson, Arizona.
authors: Jennifer L
authors: JL
authors: Becker
authors: School of Pathology and Laboratory Medicine, The University of Western Australia, Nedlands, Australia.
authors: Lesley A
authors: LA
authors: Cala
authors: Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom.
authors: Ana M
authors: AM
authors: Casado
authors: Department of Pharmacology, National University Hospital of Singapore, Singapore.
authors: Christopher
authors: C
authors: Chen
authors: Radiological Sciences Research Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
authors: Robert A
authors: RA
authors: Dineen
authors: Department of Medicine, Hawke's Bay Hospital, Hastings, New Zealand.
authors: John
authors: J
authors: Gommans
authors: Department of Neuroradiology, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom.
authors: Panos
authors: P
authors: Koumellis
authors: Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
authors: Hanna
authors: H
authors: Christensen
authors: Stroke Service, Adelaide and Meath Hospital, Dublin, Ireland.
authors: Ronan
authors: R
authors: Collins
authors: Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
authors: Anna
authors: A
authors: Czlonkowska
authors: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: Kennedy R
authors: KR
authors: Lees
authors: Department of Medicine, University of Thessaly, Larissa, Greece.
authors: George
authors: G
authors: Ntaios
authors: Department of Neurology, Selcuk University Medical Faculty, Konya, Turkey.
authors: Serefnur
authors: S
authors: Ozturk
authors: Division of Neurology, Queen Elizabeth II Health Sciences Centre, and Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors: Stephen J
authors: SJ
authors: Phillips
authors: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
authors: Nikola
authors: N
authors: Sprigg
authors: Department of Neurology, Clinical County Emergency Hospital, Targu Mures, Romania.
authors: Szabolcs
authors: S
authors: Szatmari
authors: Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom.
authors: Joanna M
authors: JM
authors: Wardlaw
authors: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom. Electronic address: philip.bath@nottingham.ac.uk.
authors: Philip M
authors: PM
authors: Bath
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects*; D004185:Disability Evaluation; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D020299:Intracranial Hemorrhage, Hypertensive / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020030:Nitric Oxide Donors / Q000008:administration & dosage* / Q000009:adverse effects; D005996:Nitroglycerin / Q000008:administration & dosage* / Q000009:adverse effects; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D020030:Nitric Oxide Donors; D005996:Nitroglycerin
keywords: Antihypertensive therapy; blood pressure; cerebrovascular disorders; glyceryl trinitrate; intracerebral hemorrhage; randomized controlled trial