For patients with acute stroke, prehospital reduction in blood pressure does not affect functional outcomes, according to a study published online May 16 in the New England Journal of Medicine to coincide with presentation at the annual European Stroke Organization Conference, held from May 15 to 17 in Basel, Switzerland.
Gang Li, M.D., Ph.D., from the Shanghai East Hospital School of Medicine, and colleagues randomly assigned patients with suspected acute stroke that caused a motor deficit and with elevated systolic blood pressure (≥150 mm Hg), who were assessed within two hours after symptom onset, to receive immediate treatment to lower systolic blood pressure or usual blood pressure management (1,205 and 1,199 patients, respectively).
The median time from symptom onset to randomization was 61 minutes, and mean blood pressure was 178/98 mm Hg at randomization. The researchers found that mean systolic blood pressure was 158 and 170 mm Hg in the intervention and usual care groups, respectively, at the time of patient arrival at the hospital. No difference was seen in functional outcome between the groups, and the two groups had a similar incidence of serious adverse events. For patients with hemorrhagic stroke (46.5 percent), prehospital reduction of blood pressure was associated with a reduction in the odds of poor functional outcomes, while an increase was seen for patients with cerebral ischemia.
“The early initiation of intravenous antihypertensive treatment to reach a systolic blood-pressure target of 130 to 140 mm Hg had no overall effect on functional outcome at 90 days as compared with usual care,” the authors write.
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