Allopurinol reduces brachial and central blood pressure, and carotid intima-media thickness progression after ischaemic stroke and transient ischaemic attack: a randomised controlled trial

Higgins, P., Walters, M. R. , Murray, H. M., McArthur, K., McConnachie, A. , Lees, K. R. and Dawson, J. (2014) Allopurinol reduces brachial and central blood pressure, and carotid intima-media thickness progression after ischaemic stroke and transient ischaemic attack: a randomised controlled trial. Heart, 100(14), pp. 1085-1092. (doi:10.1136/heartjnl-2014-305683)

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Publisher's URL: http://dx.doi.org/10.1136/heartjnl-2014-305683

Abstract

Objective Central blood pressure (CBP) and carotid intima-media thickness (CIMT) are surrogate measures of cardiovascular risk. Allopurinol reduces serum uric acid and oxidative stress and improves endothelial function and may therefore reduce CBP and CIMT progression. This study sought to ascertain whether allopurinol reduces CBP, arterial stiffness and CIMT progression in patients with ischaemic stroke or transient ischaemic attack (TIA).<p></p> Methods We performed a randomised, double-blind, placebo-controlled study, examining the effect of 1-year treatment with allopurinol (300 mg daily), on change in CBP, arterial stiffness and CIMT progression at 1 year and change in endothelial function and circulating inflammatory markers at 6 months. Patients aged over 18 years with recent ischaemic stroke or TIA were eligible.<p></p> Results Eighty participants were recruited, mean age 67.8 years (SD 9.4). Systolic CBP [−6.6 mm Hg (95% CI −13.0 to −0.3), p=0.042] and augmentation index [−4.4% (95% CI −7.9 to −1.0), p=0.013] were each lower following allopurinol treatment compared with placebo at 12 months. Progression in mean common CIMT at 1 year was less in allopurinol-treated patients compared with placebo [between-group difference [−0.097 mm (95% CI −0.175 to −0.019), p=0.015]. No difference was observed for measures of endothelial function.<p></p> Conclusions Allopurinol lowered CBP and reduced CIMT progression at 1 year compared with placebo in patients with recent ischaemic stroke and TIA. This extends the evidence of sustained beneficial effects of allopurinol to these prognostically significant outcomes and to the stroke population, highlighting the potential for reduction in cardiovascular events with this treatment strategy.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McConnachie, Dr Alex and Murray, Mrs Heather and Dawson, Professor Jesse and Lees, Professor Kennedy and Higgins, Dr Peter and McArthur, Dr Kate and Walters, Professor Matthew
Authors: Higgins, P., Walters, M. R., Murray, H. M., McArthur, K., McConnachie, A., Lees, K. R., and Dawson, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037
ISSN (Online):1468-201X

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
468541The effect of allopurinol on carotid intima-media thickness and markers of endothelial function in patients with recent stroke - a pilot studyMatthew WaltersThe Stroke Association (CHSA)TSA 2007/10RI CARDIOVASCULAR & MEDICAL SCIENCES