Prehospital Treatment to Lower Blood Pressure Does Not Improve Outcomes for Those With Acute Stroke

Results from the RIGHT-2 trial (ISRCTN26986053)presented at the International Stroke Conference in Honolulu, HI and published in The Lancet, showed that treatment with glyceryl trinitrate (GTN; also known as nitroglycerin) to lower blood pressure rapidly and early in the course of acute stroke did not improve functional outcomes for patients.

For patients who had a final diagnosis of stroke, for both patients treated with GTN and sham treatment had an mRS score of 3 at 90 days and an adjusted odds ratio of 1.25 (95% CI: 0.97-1.60; P = .083). Comparing all patients treated with GTN with all patients treated with sham also showed no significant difference with an odds ratio of 1.08 (95% CI: 0.84-1.29; P = .69). Median time to randomization was 71 minutes. The mean decrease in blood pressure for those treated with GTN was 5.8 mm Hg systolic and 2.6 mm Hg diastolic compared with those given sham treatment. 

In this study, paramedics from 8 UK ambulance services (n = 516) recruited 1,149 participants who were randomly assigned to receive transdermal GTN (n = 568) or a sham transdermal patch (n = 580). Inclusion criteria were that the patient was an adult with presumed onset of stroke within the previous 4 hours, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Patients were masked to treatment; paramedics delivering the treatment were unmasked. Follow up using the 7-level modified Rankin Scale (mRS) was done via centralized telephone interviews with the interviewers also masked to treatment.