Baseline characteristics of the 4011 patients recruited into the 'Efficacy of Nitric Oxide in Stroke' (ENOS) trial

Philip M.W. Bath, Alessandro Adami, Daniel Bereczki, Eivind Berge, Maia Beridze, Lesley Cala, Ana Casado, Valeria Caso, Hui Meng Chang, Hanne Christensen, Ronan Collins, Anna Czlonkowska, Robert A. Dineen, Anwar El Etribi, Abdul Rahman Ghani, John Gommans, Panos Koumellis, Ann Charlotte Laska, Kennedy R. Lees, Jose NavarroGeorge Ntaios, Serefnur Ozturk, Stephen Phillips, Stuart Pocock, Kameshwar Prasad, Polly Scutt, H. Asita de Silva, Szabolcs Szatmari, Díez-Tejedor Exuperio Díez-Tejedor, Sally Utton, Yong Jun Wang, M. Wardlaw Joanna, David Whynes, Lawrence Wong, Lisa Woodhouse, Nikola Sprigg

Research output: Contribution to journalArticle

17 Citations (Scopus)


Background: High blood pressure is common in acute stroke and associated with a worse functional outcome. Many patients who present with acute stroke are taking prescribed antihypertensive therapy before their stroke. Aims: ENOS tested whether lowering blood pressure and continuing pre-stroke antihypertensive therapy are each safe and effective. Methods: This study is an international multi-centre prospective randomized single-blind blinded-endpoint parallel-group partial-factorial controlled trial of transdermal glyceryl trinitrate (a nitric oxide donor, given for seven-days) vs. no glyceryl trinitrate, and of continuing vs. stopping (temporarily for seven-days) pre-stroke antihypertensive drugs if relevant, in patients with acute ischaemic stroke or intracerebral haemorrhage and high systolic blood pressure (140-220mmHg). Results: Recruitment ran from July 2001 to October 2013. Four thousand eleven patients [2097 (52·3%) in the continue/stop arm] were recruited from 173 sites across 23 countries in 5 continents (Asia 14%, Continental Europe 16%, UK 64%). Baseline characteristics include: mean age 70 (standard deviation 12) years; male 57%; mean time from stroke to recruitment 26 (13) h; mean severity (Scandinavian Stroke Scale) 34 (13) of 58; mean blood pressure 167 (19)/90 (13)mmHg; ischaemic stroke 83%; and intracerebral haemorrhage 16%. The main trial results will be presented in May 2014. The results will also be presented in updated Cochrane systematic reviews and included in individual patient data meta-analyses of all relevant randomized controlled trials. Conclusion: ENOS is a large completed international trial of blood pressure management in acute stroke and includes patients representative of many stroke services worldwide. International Journal of Stroke

Original languageEnglish
Pages (from-to)711-720
Number of pages10
JournalInternational Journal of Stroke
Issue number6
Publication statusPublished - Aug 2014


  • Acute stroke
  • Antihypertensive drugs
  • Blood pressure
  • Glyceryl trinitrate
  • Nitric oxide
  • Randomized controlled trial

ASJC Scopus subject areas

  • Neurology

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    Bath, P. M. W., Adami, A., Bereczki, D., Berge, E., Beridze, M., Cala, L., Casado, A., Caso, V., Chang, H. M., Christensen, H., Collins, R., Czlonkowska, A., Dineen, R. A., Etribi, A. E., Ghani, A. R., Gommans, J., Koumellis, P., Laska, A. C., Lees, K. R., ... Sprigg, N. (2014). Baseline characteristics of the 4011 patients recruited into the 'Efficacy of Nitric Oxide in Stroke' (ENOS) trial. International Journal of Stroke, 9(6), 711-720.