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(Hypertension. 2006;47:1209.)
© 2006 American Heart Association, Inc.

Original Articles

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

Mark Willmot; Andrew Ghadami; Beverly Whysall; Wim Clarke; Joanna Wardlaw; Philip M.W. Bath

From the Institute of Neuroscience (M.W., A.G., B.W., W.C., P.M.W.B.) University of Nottingham, Nottingham; and Division of Clinical Neurosciences (J.W.), University of Edinburgh, Edinburgh, United Kingdom.

Correspondence to Philip M. W. Bath, Division of Stroke Medicine, Institute of Neuroscience, University of Nottingham, Queen’s Medical Center, Nottingham NG7 2UH United Kingdom. E-mail philip.bath{at}nottingham.ac.uk

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 (<5 days) ischemic (n=16) or hemorrhagic (n=2) 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). GTN lowered peripheral systolic BP by (mean) 23 mm Hg (95% CI, 2 to 45; P=0.03) and central systolic BP by 22 mm Hg (95% CI, 0 to 44; P=0.048). In contrast, GTN did not alter CBF (mL/min per 100 g): global –1.2 (95% CI, –6.5 to 4.2; P=0.66) and ipsilateral hemisphere –1.4 (95% CI, –7.6 to 4.9; P=0.65) or area of stroke oligemia, penumbra, or core (as defined by critical CBF limits). Contralateral CBF did not change: hemisphere 0 (95% CI, –7 to 6; P=0.96). GTN did not alter cerebral perfusion pressure or zero-filling pressure. Significant reductions in BP after transdermal GTN are not associated with changes in CBF or cerebral perfusion pressure or cerebral steal in patients with recent stroke. Trials need to assess the effect of lowering BP on functional outcome.

Key Words: stroke • hypertension, arterial • cerebral arteries • nitric oxide • nitroglycerin

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