Abstract WP390: Regional Differences in Blood Pressure Management After Acute Stroke in International Randomized Controlled Trials

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Lili Song ◽  
Lingli Sun ◽  
Xia Wang ◽  
Tom J Moullaali ◽  
Thompson G Robinson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
South America ◽  
Acute Stroke ◽  
Sodium Nitroprusside ◽  
Regional Differences ◽  
Controlled Trial ◽  
Epidemiological Studies ◽  
Randomized Controlled ◽  
Stroke Study ◽  
To Receive

Background and Aims: Epidemiological studies show significant variations in hypertension management within and between countries. The level of regional variation in early blood pressure (BP) management after acute stroke is uncertain. Methods: Data are from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), a partial-factorial, international randomized controlled trial (RCT) of thrombolysis-eligible acute ischemic stroke (AIS) patients with systolic BP (SBP >150 mmHg) assigned to intensive (target SBP 130-140 mmHg) vs. guideline-recommended (SBP <180 mmHg) treatment; and INTERACT2, an international RCT of patients with spontaneous intracerebral hemorrhage (ICH) (<6 hours) with elevated SBP randomized to intensive (target SBP <140 mmHg) or guideline-recommended (SBP <180 mmHg) treatment. BP management was compared between five participating regions of these RCTs: west (Europe/Australia/US), China, other Asia (South Korea, Singapore, Thailand, Vietnam), India (India and Pakistan), and South America (Argentina, Chile, Brazil, Colombia). Results: There were 2196 AIS (38% women, mean age 67[12] years) and 2829 acute ICH (37% women, mean age 63[13] years) patients in these analyzes. Commonly used intravenous BP lowering agents are labetalol, nitroglycerin, and topical Nitrates in western countries; mannitol, urapidil, and sodium nitroprusside in China; nicardipine in other Asian countries; and sodium nitroprusside and labetalol in South America. Western patients were more likely to receive BP lowering treatment in the first 24 hours and treated with multiple agents, and had larger magnitude of SBP reduction and greater SBP variability. BP control parameters over 2-7 days were comparable between regions. Conclusion: Regional variations in early BP management in acute stroke translated into differences in magnitude of SBP reduction and SBP variability in patients.

scholarly journals Regional Differences in Early BP Management After Acute Ischemic Stroke in the ENCHANTED International Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Chen Chen ◽  
Lili Song ◽  
Jie Yang ◽  
Richard Lindley ◽  
Thompson Robinson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
South America ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Sodium Nitroprusside ◽  
Controlled Trial ◽  
Epidemiological Studies ◽  
Chinese Patients ◽  
Western Countries ◽  
Randomized Controlled

Background and Aims: Epidemiological studies show significant variations in hypertension management within and between countries. The level of regional variation in early blood pressure (BP) management after acute stroke is uncertain.Methods: Data are from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), a partial-factorial, international randomized controlled trial of thrombolysis-eligible acute ischemic stroke (AIS) patients with elevated systolic BP (SBP &gt;150 mmHg) assigned to intensive (target SBP 130-140 mmHg) vs. guideline-recommended (SBP &lt;180 mmHg) treatment; BP management was compared among four regions: Western countries (Italy/United Kingdom/Spain/Australia), China (mainland), other Asia (Hong Kong/Taiwan/Singapore/Thailand/Vietnam/India), and South America (Chile/Brazil/Colombia).Results: These analyses included 2,196 AIS [38% women, mean age 67 (12) years] patients. Commonly used intravenous BP-lowering agents were labetalol, nitroglycerin, and topical nitrates in Western countries; urapidil and sodium nitroprusside in China; nicardipine in other Asian countries; and sodium nitroprusside and labetalol in South America. Chinese patients were less likely to receive BP-lowering treatment in the first 24 h and be treated with multiple agents although they had smaller magnitude of SBP reduction and lower SBP variability.Conclusion: Regional variations in early BP management in acute stroke translated into differences in early BP control parameters.

scholarly journals Baseline characteristics of the 1149 patients recruited into the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2) randomized controlled trial

2018 ◽  
Vol 14 (3) ◽  
pp. 298-305 ◽  
Author(s):  
Philip M Bath ◽  
Polly Scutt ◽  
Jason P Appleton ◽  
Mark Dixon ◽  
Lisa J Woodhouse ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Glyceryl Trinitrate ◽  
Acute Stroke ◽  
Controlled Trial ◽  
Nitric Oxide Donor ◽  
Main Trial ◽  
Randomized Controlled ◽  
Baseline Characteristics ◽  
The Uk ◽  
Stroke Trial

Background High blood pressure is common in acute stroke and associated with a worse functional outcome. Glyceryl trinitrate, a nitric oxide donor, lowers blood pressure in acute stroke and may improve outcome. Aims Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2) tested the feasibility of performing a UK multicenter ambulance-based stroke trial, and the safety and efficacy of glyceryl trinitrate when administered by paramedics before hospital admission. Methods Paramedic-led ambulance-based multicenter prospective randomized single-blind blinded-endpoint parallel-group controlled trial of transdermal glyceryl trinitrate (given for four days) versus sham in patients with ultra-acute (<4 h) presumed stroke. Data are number (%), median (interquartile range) or mean (standard deviation). Results Recruitment ran from October 2015 to 31 May 2018. A total 1149 patients were recruited from eight UK ambulance services and taken to 54 acute hospitals. Baseline characteristics include: mean age 73 (15) years; female 555 (48%); median time from stroke to randomization 70 (45, 115) min; face-arm-speech scale score 2.6 (0.5); and blood pressure 162 (25)/92 (18) mmHg. The final diagnosis was ischemic stroke 52%, hemorrhagic stroke 13%, Transient Ischemic Attack (TIA) 9%, and mimic 25%. The main trial results will be presented in quarter 4 2018. The results will also be included in updated Cochrane systematic reviews, and individual patient data meta-analyses of all relevant randomized controlled trials. Conclusion It was feasible to perform a multicenter ambulance-based ultra-acute stroke trial in the UK and to treat with glyceryl trinitrate versus sham. The relatively unselected cohort of stroke patients is broadly representative of those admitted to hospital in the UK. Trial registration ISRCTN26986053.

scholarly journals Acupuncture for acute stroke: study protocol for a multicenter, randomized, controlled trial

Trials ◽  
2014 ◽  
Vol 15 (1) ◽  
pp. 214 ◽  
Author(s):  
Lifang Chen ◽  
Jianqiao Fang ◽  
Ruijie Ma ◽  
Ronen Froym ◽  
Xudong Gu ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Acute Stroke ◽  
Study Protocol ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Stroke Study ◽  
Multicenter Randomized Controlled Trial

scholarly journals Oral nifedipine versus intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy: a randomized controlled trial

2019 ◽  
Vol 8 (5) ◽  
pp. 1921
Author(s):  
Anjuman Alam ◽  
S. M. A. Zakaria
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Urine Output ◽  
Gestational Hypertension ◽  
Controlled Trial ◽  
Pressure Control ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Hypertensive Emergencies ◽  
To Receive

Background: To compare intravenous labetalol with oral nifedipine in terms of rapidity at which they control blood pressure in acute hypertensive emergencies of pregnancy.Methods: A randomized controlled study. Pregnant women with severe gestational hypertension with BP ≥160/110 mmHg after ≥20 weeks of gestation were randomized with computer generated numbers, either to receive IV labetalol with an escalating dose of 20, 40, 80, 80 and 80 mg or nifedipine capsule orally in a dose of 10 mg every 15 minutes (upto 5 doses) until a BP of ≤150/100 mmHg is achieved. Crossover treatment was to be effected if initial treatment regimen was unsuccessful. Primary outcome was time taken and number of doses required to achieve the target BP of ≤150/100 mmHg. Secondary outcomes were volume of urine output, maternal heart rate changes, fetal heart rate abnormality, perinatal and maternal outcome and side effects.Results: Oral nifedipine achieved the target BP (≤150/100 mmHg) more rapidly in (26.25±12.60) minutes in comparison to (32.62±12.19) minutes with IV labetalol (p= 0.024). Nifedipine group also took less number of doses to achieve the target BP of (≤150/100 mmHg) mmHg than IV labetalol (1.75±0.840 vs. 2.18±0.83), p= 0.024. Volume of urine output was also significantly more in nifedipine group (94.90±1.84 ml) at 1 hour and thereafter till 24 hour of treatment in comparison to IV labetalol (41.28±2.14 ml), p= 0.000. Side effects are few and not serious. No patient required crossover treatment.Conclusions: Both the drugs are equally effective in controlling acute hypertensive emergencies of pregnancy, however oral nifedipine is more rapid in controlling severe hypertension and also it is associated with significantly increased urine output.

scholarly journals Hydralazine versus Labetalol for acute control of blood pressure in patients with severe pre-eclampsia: a randomized controlled trial

2019 ◽  
Vol 8 (4) ◽  
pp. 1626
Author(s):  
Nayanika Gaur ◽  
Priyanka Kathuria
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trial ◽  
Statistical Tests ◽  
Controlled Trial ◽  
Primary Objective ◽  
Target Blood Pressure ◽  
Double Blind ◽  
Randomized Controlled ◽  
To Receive ◽  
Sustained Increase

Background: Authors sought to compare the effectively of intravenous hydralazine and intravenous labetalol in controlling acute rise in blood pressure in patients with severe preeclampsia.Methods: In this double-blind randomized controlled trial, all pregnant women with sustained increase in blood pressure (BP) of 160 mmHg systolic or 110 mmHg diastolic or higher were randomized to receive intravenous (IV) hydralazine 5 mg (max. 4 doses) or IV labetalol in escalating doses of 20mg, 40mg, 80mg, 80mg to achieve target blood pressure of 150 mmHg systolic and 100 mmHg diastolic or lower. The primary objective of the study was to assess the time taken to control blood pressure. Secondary agendas were the number of repeat doses required and other side effect profile.Results: In the study duration of September 2015 to September 2017, authors enrolled 60 participants for our trial. The median time taken to achieve the target blood pressure was 22.4 minutes in both the groups. Close to half of the participants did not require repeat doses (46.66% with labetalol and 50% with hydralazine). No serious maternal or foetal side effects were noted during the study. Statistical tests were performed using SPSS for Windows version 22.Conclusions: As operated in the study, the efficacy of hydralazine and labetalol to control the acute rise in blood pressure is similar.

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