Relationship between nitrate headache and outcome in patients with acute stroke: results from the efficacy of nitric oxide in stroke (ENOS) trial

Stroke and Vascular Neurology

article

Lucy Beishon¹  Lisa J Woodhouse¹  Daniel Bereczki²  Hanne K Christensen³  Ronan Collins⁴  John Gommans⁵  Christina Kruuse⁶  George Ntaios⁷  Serefnur Ozturk⁸  Stephen Phillips⁹  Stuart Pocock^1,10  Szabolcs Szatmari^1,11  Joanna Wardlaw^1,12  Nikola Sprigg¹  Philip M Bath¹ 

[1] Stroke Trials Unit, Division of Clinical Neuroscience , University of Nottingham;Department of Neurology , Semmelweis University;Bispebjerg Hospital and University of Copenhagen , University of Copenhagen;Department of Geriatric and Stroke Medicine , Adelaide and Meath Hospital;Department of Medicine , Hawke's Bay Hospital;Department of Neurology, Herlev Gentofte Hospital , University of Copenhagen;Department of Medicine, Larissa University Hospital , University of Thessaly;Department of Neurology , Selcuk University Medical Faculty;Department of Neurology , Queen Elizabeth II Health Sciences Centre;Medical Statistics Unit , London School of Hygiene & Tropical Medicine;Department of Neurology , George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș;Centre for Clinical Brain Sciences , University of Edinburgh;Stroke , Nottingham University Hospitals NHS Trust

关键词: intervention;    stroke;    blood pressure;   

DOI  :  10.1136/svn-2020-000498

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

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.

【 授权许可】

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