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Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet].

Nitric oxide donors (nitrates), L‐arginine, or nitric oxide synthase inhibitors for acute stroke

This version published: 2008; Review content assessed as up-to-date: August 12, 2002.

Plain language summary

Glyceryl trinitrate (GTN) lowers blood pressure in patients with acute stroke. Nitric oxide is a key molecule involved in regulation of blood pressure and control of brain activity, both before and during stroke. As such, drugs which produce nitric oxide or control its production might be beneficial in acute stroke. Two small trials of GTN, a nitric oxide donor, have been completed, involving 127 patients with acute stroke, and show that it lowers blood pressure; however, these studies were too small to assess whether GTN is safe and effective in improving outcome and a further large trial capable of answering this question is underway. No other studies of nitric oxide donors or modulating drugs have been performed. At present, these classes of drugs should not be used in the routine management of acute stroke.

Abstract

Background: Nitric oxide has several effects that may be beneficial in ischaemic stroke and useful in the management of high blood pressure in acute stroke. Some forms of nitric oxide synthase inhibition may also be beneficial. However, high concentrations of nitric oxide are likely to be toxic to brain tissue.

Objectives: To assess the effects of nitric oxide donors, L‐arginine, or nitric oxide synthase‐inhibitors in people with acute stroke.

Search methods: We searched the Cochrane Stroke Group Trials Register (last searched in March 2002), EMBASE (1980 to March 2002), MEDLINE (1966 to March 2002), and ISI Science Citation Indexes (1981 to March 2002). We contacted drug companies and researchers in the field.

Selection criteria: Randomised and quasi‐randomised trials comparing nitric oxide donors, L‐arginine, or nitric oxide synthase‐inhibitors in patients within one week of onset of confirmed stroke.

Data collection and analysis: Two reviewers independently applied the inclusion criteria. The data are given as weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CI).

Main results: Two small completed trials (127 patients) of transdermal glyceryl trinitrate (GTN), a nitric oxide donor, were found. GTN lowered 24‐hour ambulatory systolic blood pressure by 7.9 mmHg (95% CI 0.1, 15.8) and increased heart rate (WMD 6.2 beats per minute, 95% CI 2.7, 9.8). Treatment with GTN was not associated with statistically significant effects on end‐of‐treatment death, or combined death or deterioration, or end‐of‐trial death, combined death or dependency, or combined death or institutionalisation.

Authors' conclusions: There is currently insufficient evidence from randomised trials on the effects of nitric oxide donors, L‐arginine, or nitric oxide synthase‐inhibitors in patients with acute stroke to recommend their use. A large controlled trial of glyceryl trinitrate patches is underway.

Editorial Group: Cochrane Stroke Group.

Publication status: Edited (no change to conclusions).

Citation: Bath PMW, Willmot MM, Leonardi‐Bee J, Bath‐Hextall FJ. Nitric oxide donors (nitrates), L‐arginine, or nitric oxide synthase inhibitors for acute stroke. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD000398. DOI: 10.1002/14651858.CD000398. Link to Cochrane Library. [PubMed: 12519542]

Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

PMID: 12519542

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