New Engl J Med
Prehospital BP reduction: Does it improve stroke outcomes?
May 22, 2024
Prehospital BP reduction didn't improve functional outcomes in a cohort of patients with undifferentiated acute stroke, of whom 46.5% subsequently received a diagnosis of hemorrhagic stroke.
Researchers randomly assigned 2,404 patients (mean age, 70 years) in China with suspected acute stroke that caused a motor deficit and with elevated systolic BP (≥150 mm Hg), who were assessed in the ambulance within 2 hours after the onset of symptoms, to receive immediate treatment to lower systolic BP (target range, 130 to 140 mm Hg) (intervention group) or usual BP management (usual-care group).
- Median time between symptom onset and randomization was 61 minutes and mean BP at randomization was 178/98 mm Hg. Stroke was subsequently confirmed by imaging in 2,240 patients, of whom 1,041 (46.5%) had a hemorrhagic stroke.
- At the time of patients' arrival at the hospital, mean systolic BP in the intervention group was 158 mm Hg vs. 170 mm Hg in the usual-care group.
- Overall, there was no difference in functional outcome between the two groups (common odds ratio [OR], 1.00) and the incidence of serious adverse events was similar between groups.
- Prehospital reduction of BP was associated with a decrease in odds of a poor functional outcome among patients with hemorrhagic stroke (common OR, 0.75; 95% CI, 0.60 to 0.92) but an increase among patients with cerebral ischemia (common OR, 1.30; 95% CI, 1.06 to 1.60).
Source:
Li G, et al. (2024, May New Engl J Med. Intensive Ambulance-Delivered Blood-Pressure Reduction in Hyperacute Stroke. https://pubmed.ncbi.nlm.nih.gov/38752650/
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