Browsing by Author "Krishnan, K."

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Ceramic analysis of the Anuradhapura hinterland
(University of Kelaniya, 2008) Krishnan, K.; Adikari, G.
Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomised controlled trial
(Lancet Publishing Group, 2015) Bath, P.M.; Woodhouse, L; Scutt, P.; Krishnan, K.; Wardlaw, J.M.; Bereczki, D.; Sprigg, N.; Berge, E.; Beridze, M.; Caso, V.; Chen, C.; Christensen, H.; Collins, R.; El Etribi, A.; Laska, A. C.; Lees, K. R.; Ozturk, S.; Phillips, S.; Pocock, S.; de Silva, H.A.; Szatmari, S.; Utton, S.; ENOS Trial Investigators(955)
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. FUNDING: UK Medical Research Council.
Glyceryl Trinitrate for Acute Intracerebral Hemorrhage: Results From the Efficacy of Nitric Oxide in Stroke (ENOS) Trial, a Subgroup Analysis
(Dallas : American Heart Association, 2016) Krishnan, K.; Scutt, P.; Woodhouse, L.; Adami, A.; Becker, J.L.; Berge, E.; Cala, L.A.; Casado, A.M.; Caso, V.; Chen, C.; Christensen, H.; Collins, R.; Czlonkowska, A.; Dineen, R.A.; Gommans, J.; Koumellis, P.; Lees, K.R.; Ntaios, G.; Ozturk, S.; Phillips, S.J.; Pocock, S.J.; de Silva, A.; Sprigg, N.; Szatmari, S.; Wardlaw, J.M.; Bath, P.M.
BACKGROUND AND PURPOSE: The Efficacy of Nitric Oxide in Stroke (ENOS) trial found that transdermal glyceryl trinitrate (GTN, a nitric oxide donor) lowered blood pressure but did not improve functional outcome in patients with acute stroke. However, GTN was associated with improved outcome if patients were randomized within 6 hours of stroke onset. METHODS: In this prespecified subgroup analysis, the effect of GTN (5 mg/d for 7 days) versus no GTN was studied in 629 patients with intracerebral hemorrhage presenting within 48 hours and with systolic blood pressure ≥140 mm Hg. The primary outcome was the modified Rankin Scale at 90 days. RESULTS: Mean blood pressure at baseline was 172/93 mm Hg and significantly lower (difference -7.5/-4.2 mm Hg; both P≤0.05) on day 1 in 310 patients allocated to GTN when compared with 319 randomized to no GTN. No difference in the modified Rankin Scale was observed between those receiving GTN versus no GTN (adjusted odds ratio for worse outcome with GTN, 1.04; 95% confidence interval, 0.78-1.37; P=0.84). In the subgroup of 61 patients randomized within 6 hours, GTN improved functional outcome with a shift in the modified Rankin Scale (odds ratio, 0.22; 95% confidence interval, 0.07-0.69; P=0.001). There was no significant difference in the rates of serious adverse events between GTN and no GTN. CONCLUSIONS: In patients with intracerebral hemorrhage within 48 hours of onset, GTN lowered blood pressure was safe but did not improve functional outcome. Very early treatment might be beneficial but needs assessment in further studies.
The state of theocracy: defining an early medieval hinterland in Sri Lanka
(University of Kelaniya, 2008) Coningham, R.; Gunawardhana, P.; Manuel, M.; Adhikari, G.; Katugampola, M.; Young, R.; Schmidt, A.; Krishnan, K.; Simpson, I.; McDonnell, G.; Batt, C.