Evidence map›Paper›PMID 30626285›Full record

Trial reportStroke2019

Effect of Glyceryl Trinitrate on Hemodynamics in Acute Stroke.

Jason P Appleton, Lisa J Woodhouse, Daniel Bereczki, Eivind Berge, Hanne K Christensen, Rónán Collins, John Gommans, George Ntaios, Serefnur Ozturk, Szabolcs Szatmari and 5 more

Open access · greenAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Stroke, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
1.0field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 8 citations in OpenAlex.

  1. Article
  2. Article
  3. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 11 institutions in 9 countries.

Jason P AppletonFrom the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (J.P.A., L.J.W., N.S., P.M.B.).
Lisa J WoodhouseFrom the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (J.P.A., L.J.W., N.S., P.M.B.).
Daniel BereczkiDepartment of Neurology, Semmelweis University, Budapest, Hungary (D.B.).
Eivind BergeDepartment of Internal Medicine and Cardiology, Oslo University Hospital, Norway (E.B.).
Hanne K ChristensenDepartment of Neurology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark (H.K.C.).
Rónán CollinsStroke Services, Trinity College Dublin, Tallaght Hospital, Ireland (R.C.).
John GommansDepartment of Medicine, Hawke's Bay District Health Board, Hastings, New Zealand (J.G.).
George NtaiosDepartment of Medicine, University of Thessaly, Larissa, Greece (G.N.).
Serefnur OzturkDepartment of Neurology, Selcuk University Faculty of Medicine, Konya, Turkey (S.O.).
Szabolcs SzatmariDepartment of Neurology, Clinical County Emergency Hospital, Targu Mures, Romania (S.S.).
Joanna M WardlawDivision of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, (J.M.W.).
Nikola SpriggFrom the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (J.P.A., L.J.W., N.S., P.M.B.).
Peter M RothwellNuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom (P.M.R.).
Philip M BathFrom the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (J.P.A., L.J.W., N.S., P.M.B.).
ENOS Investigators
University of Nottingham · GBFrederiksberg Hospital · DKHawke's Bay Hospital · NZNottingham University Hospitals NHS Trust · GBOslo University Hospital · NOSelçuk University · TRSemmelweis University · HUSpitalul Clinic Judetean de Urgenta Târgu Mureş · ROTallaght University Hospital · IEUniversity of Edinburgh · GBUniversity of Thessaly · GR

Funding

British Heart Foundation CS/14/4/30972Medical Research Council G0501797
6 · The paper itself

Abstract

Background and Purpose- Increased blood pressure (BP), heart rate, and their derivatives (variability, pulse pressure, rate-pressure product) are associated with poor clinical outcome in acute stroke. We assessed the effects of glyceryl trinitrate (GTN) on hemodynamic parameters and these on outcome in participants in the ENOS trial (Efficacy of Nitric Oxide in Stroke). Methods- Four thousand and eleven patients with acute stroke and raised BP were randomized within 48 hours of onset to transdermal GTN or no GTN for 7 days. Peripheral hemodynamics were measured at baseline (3 measures) and daily (2 measures) during treatment. Between-visit BP variability over days 1 to 7 (as SD) was assessed in quintiles. Functional outcome was assessed as modified Rankin Scale and cognition as telephone mini-mental state examination at day 90. Analyses were adjusted for baseline prognostic variables. Data are mean difference or odds ratios with 95% CI. Results- Increased baseline BP (diastolic, variability), heart rate, and rate-pressure product were each associated with unfavorable functional outcome at day 90. Increased between-visit systolic BP variability was associated with an unfavourable shift in modified Rankin Scale (highest quintile adjusted odds ratio, 1.65; 95% CI, 1.37-1.99), worse cognitive scores (telephone mini-mental state examination: highest quintile adjusted mean difference, -2.03; 95% CI, -2.84 to -1.22), and increased odds of death at day 90 (highest quintile adjusted odds ratio, 1.57; 95% CI, 1.12-2.19). GTN lowered BP and rate-pressure product and increased heart rate at day 1 and reduced between-visit systolic BP variability. Conclusions- Increased between-visit BP variability was associated with poor functional and cognitive outcomes and increased death 90 days after acute stroke. In addition to lowering BP and rate-pressure product, GTN reduced between-visit systolic BP variability. Agents that lower BP variability in acute stroke require further study.

Indexed as

NitroglycerinStrokeAcute DiseaseAdministration, CutaneousAgedAged, 80 and overBlood PressureFemaleHumansMaleMiddle AgedTime FactorsNitroglycerinblood pressureglyceryl trinitrateheart ratehemodynamicshemorrhage

Identifiers

PMID30626285
PMCPMC6358219
OpenAlexW2908985231

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.