Effect of Perindopril on Cerebral and Renal Perfusion on Normotensives in Mild Early Ischaemic Stroke: A Randomized Controlled Trial

Nazir, Fozia; Overell, James; Bolster, Alison; Hilditch, T. E.; Lees, Kennedy R.

doi:10.1159/000082783

Cited by 43 publications

(24 citation statements)

References 26 publications

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“…Small studies looking at surrogate markers of cerebral blood flow such as SPECT have indicated that neither perindopril nor losartan lower cerebral blood flow when given within 2–7 days of stroke onset [370]. Several ongoing trials are examining whether BP should be lowered after acute stroke, and whether antihypertensive therapy should be continued or stopped in the first few days after stroke [371, 372].…”

Section: General Stroke Treatmentmentioning

confidence: 99%

Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008

Ringleb¹,

Bousser²,

Ford³

et al. 2008

Cerebrovasc Dis

2,114

567

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This article represents the update of the European Stroke Initiative Recommendations for Stroke Management. These guidelines cover both ischaemic stroke and transient ischaemic attacks, which are now considered to be a single entity. The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation.

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Section: General Stroke Treatmentmentioning

confidence: 99%

Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008

Ringleb¹,

Bousser²,

Ford³

et al. 2008

Cerebrovasc Dis

2,114

567

View full text Add to dashboard Cite

show abstract

“…Several drug classes were studied including angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor antagonists (ARA), calcium channel blockers (CCBs), diuretics and nitrates [13,14,15,16,17,18,19]. Overall, no drug class showed a decrease in CBF, and some studies of CCBs (albeit non-randomised) suggested an increase [12].…”

Section: Effects Of Antihypertensive Agents On Cbfmentioning

confidence: 99%

“…Three ACE-I (captopril, lisinopril, perindopril) have been assessed across five randomised trials involving a total of 221 patients [14, 15, 18, 20, 21]. In one study, perindopril lowered BP without having detrimental effects on CBF [15].…”

Section: Effects Of Antihypertensive Agents On Outcomementioning

confidence: 99%

High Blood Pressure in Acute Ischaemic Stroke – Broadening Therapeutic Horizons

2009

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High blood pressure (BP) is present in 80% of patients with acute ischaemic stroke and is independently associated with poor outcome. Although this epidemiology suggests that BP should be lowered acutely, concerns about dysfunctional cerebral autoregulation suggest otherwise. Several small randomised trials have assessed cerebral blood flow with various antihypertensive classes and agents in acute ischaemic stroke. Overall, these studies showed no change in cerebral perfusion, although the numbers of studies and patients are limited and there are methodological problems with some trials. There are no large published randomised trials assessing outcome with BP lowering in acute stroke. Calcium channel blockers did not alter outcome after ischaemic stroke (29 trials, 7,665 patients). However, some trials, especially those testing intravenous calcium channel blockers (INWEST) or oral β-receptor antagonists (BEST) reported real or potential hazard. In contrast, oral candesartan reduced combined vascular events in 339 patients with ischaemic stroke (ACCESS) although it had no effect on disability. The CHHIPS trial found that death was reduced in patients randomised to active treatment (labetalol, lisinopril) as compared with placebo. Two larger trials reported that glucose-potassium-insulin therapy (GIST) or magnesium (IMAGES) lowered BP but had no effect on functional outcome. The INTERACT pilot trial studied patients with intracerebral haemorrhage and found that an intensive BP-lowering regime non-significantly reduced haematoma expansion. There are four large ongoing trials examining whether to continue or stop pre-stroke antihypertensive therapy (COSSACS, ENOS) or lower BP in acute stroke (ENOS, SCAST) or haemorrhage (INTERACT 2).

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“…The normalization of blood pressure has been shown to mostly occur over a period of 4–5 days [1, 4] and we have only studied the first 48 h after stroke. It is likely, however, that therapeutic manipulation of blood pressure would begin during these first 48 h, so we chose to focus on this period, though we note that Nazir et al[ 20] studied blood pressure lowering with perindopril in a subgroup recruited up to 8 days after stroke. Our study did not include a protocol for the use of antihypertensive therapy because we felt there was insufficient evidence to guide the development of a protocol.…”

Section: Discussionmentioning

confidence: 99%

The Time Course and Determinants of Blood Pressure within the First 48 h after Ischemic Stroke

et al. 2007

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Background and Purpose: Previous research suggests that blood pressure falls acutely after ischemic stroke. We aimed to further characterize this fall with a statistical technique that allows the application of regression techniques to serial blood pressure outcome data. Methods: In a prospectively recruited ischemic stroke cohort, systolic (SBP) and diastolic (DBP) blood pressure was recorded every 4 h until 48 h after stroke. Potential determinants of blood pressure, including stroke severity and acute infection, were also recorded. Mixed effects models were used to model serial blood pressure measurements over time, adjusted for significant determinants. Results: In 156 patients, SBP and DBP fell by 14.9 mm Hg (95% CI 6.2–22.6 mm Hg) and 6.2 mm Hg (95% CI 1.4–10.6 mm Hg), respectively, over the first 48 h after stroke. SBP was higher in patients with premorbid hypertension, a previous history of stroke or TIA, current alcohol use, increasing age, stroke of mild to moderate severity (NIHSS 3–13) and in patients treated with antihypertensives. SBP was lower in smokers. There was a progressive rise in SBP in patients with acute infection. No factors other than time were associated with DBP. Conclusions: The use of mixed effects models has identified a linear SBP and DBP fall over the first 48 h after stroke. The timing and magnitude of this fall should be accounted for in the design of future prognostic and intervention studies.

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Effect of Perindopril on Cerebral and Renal Perfusion on Normotensives in Mild Early Ischaemic Stroke: A Randomized Controlled Trial

Cited by 43 publications

References 26 publications

Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008

Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack 2008

High Blood Pressure in Acute Ischaemic Stroke – Broadening Therapeutic Horizons

The Time Course and Determinants of Blood Pressure within the First 48 h after Ischemic Stroke

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