Transdermal Glyceryl Trinitrate Lowers Blood Pressure and Maintains Cerebral Blood Flow in Recent Stroke

Abstract

Abstract-High blood pressure (BP) is common in acute stroke and is independently associated with a poor outcome.Lowering BP might improve outcome if it did not adversely affect cerebral blood flow (CBF) or cerebral perfusion pressure. We investigated the effect of glyceryl trinitrate ([GTN] an NO donor) on quantitative CBF, BP, and cerebral perfusion pressure in patients with recent stroke. Eighteen patients with recent (Ͻ5 days) ischemic (nϭ16) or hemorrhagic (nϭ2) stroke were randomly assigned (2:1) to transdermal GTN (5 mg) or control. CBF (global, hemispheric, arterial territory, and lesion, using xenon computed tomography) and BP (peripheral and central) were measured before and 1 hour after treatment with GTN. The effects of GTN on CBF and BP were adjusted for baseline measurements (ANCOVA

Effect of Nitric Oxide Donors on Blood Pressure and Pulse Pressure in Acute and Subacute Stroke

“…[11][12][13] A non randomised comparison of intravenous sodium nitroprusside in patients with acute ischaemic stroke and normal older volunteers was excluded. [18] The trials included a total of 145 patients (NO donor 93, control 52) and each assessed transdermal glyceryl trinitrate (GTN), an organic nitrate.…”

“…Each trial was randomised and treatment allocation was concealed; one trial was double-blind placebo controlled [11] and the other two single-blind (table 1). [12,13] All three trials included patients with either ischaemic stroke or primary intracerebral haemorrhage. Patients were enrolled within 75 hours of stroke onset (table 1).…”

“…Two trials studied GTN given at a dose of 5 mg, [11,13] the other had three active arms with GTN used at (i) 5mg for 10 days; (ii) 5mg for 4 days followed by 10mg for 6 days; and (iii) 10mg for 10 days (table 1). To allow for this difference in doses, the data from this trial were separated into two, patients receiving 5mg or 5mg followed by 10mg (the increased dose was started at day 4 and therefore will not have affected BP measurements at baseline or after first dosing) and those receiving 10mg for the duration of the trial.…”

“…Two trials used 24 hour ambulatory blood pressure monitoring, [11,12] whereas one reported BP using a validated digital readout oscillometric device (Omron 705CP) at 1-2 hours post treatment. [13] Use of automated BP monitors means readings were effectively made blinded to treatment allocation. 9 …”

Intravenous Infusion of Nitroglycerine Leads to Increased Permeability on Dynamic Contrast-Enhanced MR Imaging in Pig Brains

“…10,11 Intravenous infusion of NTG, 0.1-0.5 g/ kg, in healthy human volunteers has been studied by using H 2 [ 15 O]-PET, and the study has shown that nitroglycerin increased global CBF. 12 However, the use of transdermal NTG (5 mg) in patients with acute stroke was not associated with changes in CBF, cerebral perfusion pressure, or cerebral steal when studied by using xenon-enhanced CT. 13 Accordingly, others have demonstrated that the blood oxygen level-dependent MR signal was inversely related to CBF but did not change during administration of NTG in humans. This finding could indicate that NTG only exerts an effect on the large vessels.…”