Which way does your doctor recommend you get your nitric oxide?
Does your doctor even know the benefits of nitric oxide for stroke?
Modulation of Adult Neurogenesis by the Nitric Oxide System
Efficacy of Nitric Oxide in Stroke' (ENOS) study
Inhaled Nitric Oxide Protects Males But not Females from Neonatal Mouse Hypoxia–Ischemia Brain Injury
Nitric oxide-induced calcium release via ryanodine receptors regulates neuronal function
The latest here:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961121-1/abstract?rss=yes
The ENOS Trial Investigators†Summary
Background
High
blood pressure is associated with poor outcome after stroke. Whether
blood pressure should be lowered early after stroke, and whether to
continue or temporarily withdraw existing antihypertensive drugs, is not
known. We assessed outcomes after stroke in patients given drugs to
lower their blood pressure.
Methods
In
our multicentre, partial-factorial trial, we randomly assigned patients
admitted to hospital with an acute ischaemic or haemorrhagic stroke and
raised systolic blood pressure (systolic 140—220 mm Hg) to 7 days of
transdermal glyceryl trinitrate (5 mg per day), started within 48 h of
stroke onset, or to no glyceryl trinitrate (control group). A subset of
patients who were taking antihypertensive drugs before their stroke were
also randomly assigned to continue or stop taking these drugs. The
primary outcome was function, assessed with the modified Rankin Scale at
90 days by observers masked to treatment assignment. This study is
registered, number ISRCTN99414122.
Findings
Between
July 20, 2001, and Oct 14, 2013, we enrolled 4011 patients. Mean blood
pressure was 167 (SD 19) mm Hg/90 (13) mm Hg at baseline (median 26 h
[16—37] after stroke onset), and was significantly reduced on day 1 in
2000 patients allocated to glyceryl trinitrate compared with 2011
controls (difference −7·0 [95% CI −8·5 to −5·6] mm Hg/—3·5 [—4·4 to
−2·6] mm Hg; both p<0·0001), and on day 7 in 1053 patients allocated
to continue antihypertensive drugs compared with 1044 patients
randomised to stop them (difference −9·5 [95% CI −11·8 to −7·2] mm
Hg/—5·0 [—6·4 to −3·7] mm Hg; both p<0·0001). Functional outcome at
day 90 did not differ in either treatment comparison—the adjusted common
odds ratio (OR) for worse outcome with glyceryl trinitrate versus no
glyceryl trinitrate was 1·01 (95% CI 0·91—1·13; p=0·83), and with
continue versus stop antihypertensive drugs OR was 1·05 (0·90—1·22;
p=0·55).
Interpretation
In
patients with acute stroke and high blood pressure, transdermal
glyceryl trinitrate lowered blood pressure and had acceptable safety but
did not improve functional outcome. We show no evidence to support
continuing prestroke antihypertensive drugs in patients in the first few
days after acute stroke.
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