BACKGROUND
Whether very early BP control in the ambulance improves outcomes among patients with undifferentiated acute stroke is uncertain.
METHODS
We randomly assigned ambulance-assessed patients with suspected acute stroke causing a motor deficit within 2-hours of onset and elevated systolic BP (≥150mmHg) to immediate BP-lowering (target 130-140mmHg) or usual BP management. The primary efficacy outcome was scores on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90-days.
RESULTS
Among the 2404 randomized patients, 1205 in the prehospital BP-reduction group and 1199 in the usual-care BP management group, with a mean BP 178/98mmHg at a median 61 min (IQR 41-93) from symptom onset with subsequent imaging-confirmed stroke, including 1041 (46.5%) of 2240 patients with a hemorrhagic stroke. At hospital arrival, mean systolic BP was 158mmHg in the prehospital group and 170mmHg in the usual-care group. Overall, there was no difference in the functional outcome between the two groups (common odds ratio [OR] 1.00; 95% confidence interval [CI] 0.87-1.15). Between-group rates of serious adverse events were similar. The prehospital BP-reduction group with hemorrhagic stroke was associated with a lower odds of a poor functional outcome (OR 0.75; 95%CI 0.60-0.92) whereas the group with cerebral ischemia was associated with a higher odds of a poor functional outcome (OR 1.30; 95%CI 1.06-1.60), as compared to patients with these stroke types who received usual-care BP management.
CONCLUSIONS