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Intensive Ambulance-Delivered Blood-Pressure Reduction in Hyperacute Stroke.

N Engl J Med

May 2024

From the Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University (G.L., C.C., F.L., D.H., Y.Z., L.Z., G.M., Y.Y., J.H., Xiahong Xu, X. Xiong, Y.T.), the Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University (C.S.A., L. Song), Shanghai Pudong New District Medical Emergency Center (C.Z.), the Department of Neurology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine (F.W.), the Department of Neurology, Shanghai Pudong New District People's Hospital (X.Z.), the Department of Neurology, Gongli Hospital, Pudong New Area (M.J.), and the Department of Neurology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital (Xiaoyun Xu), Shanghai, the First Affiliated Hospital of Chengdu Medical College (Y.L., Y.G., J. Yu, S.L., S.H., F.M., Q.T.), the International Clinical Research Center, Chengdu Medical College (Y.L.), the Department of Neurology (J. Yang, S.T., N.Y., B.L., J.G.), the Institute of Neurology (J. Yang), Sichuan Provincial Key Laboratory for Human Disease Gene Study (J. Yang, S.T.), and the Departments of Neurosurgery (R.X.) and Emergency Medicine (M.S.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, and the First People's Hospital of Shuangliu District, Chengdu/West China (Airport) Hospital Sichuan University (Y.H.), Chengdu, the George Institute for Global Health China, Beijing (C.S.A., C.C., X.R., M.O., L. Song), Zigong Fourth People's Hospital, Zigong (P.X.), Fushun County People's Hospital, Fushun (L.W.), Kaijiang County People's Hospital, Kaijiang (D.Q.), QianWei County People's Hospital, Leshan (Y.P.), Dazhu People's Hospital, Dazhu (C.L.), the Department of Neurology, Yucheng People's Hospital, Yucheng (J.L.), the Department of Neurology, Sixian People's Hospital, Suzhou (Y.W.), Guanghan People's Hospital, Guanghan (X.W.), and the Department of Neurology, Xuzhou Central Hospital, Xuzhou (G.C.) - all in China; the George Institute for Global Health, Faculty of Medicine, University of New South Wales (C.S.A., C.C., L.B., Q.L., X.C., X.L., X.R., L.L., H.L., M.O., L. Song), the Neurology Department, Royal Prince Alfred Hospital (C.S.A.), Menzies Centre for Health Policy and Economics, University of Sydney (H.L.), Sydney Institute for Women, Children and Their Families, Sydney Local Health District (H.L.), and the School of Health Sciences, Western Sydney University (L. Si) - all in Sydney; the Department of Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); the Stroke Trials Unit, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham (P.M.B.), Radcliffe Department of Medicine, University of Oxford, Oxford (G.A.F., N.S.), and the University of Leicester, Leicester (T.R.) - all in the United Kingdom; the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the University of California, Los Angeles, Los Angeles (J.L.S.); and the Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (H.B.W.).

Gang Li Yapeng Lin Jie Yang Craig S Anderson Chen Chen

Background: Treatment of acute stroke, before a distinction can be made between ischemic and hemorrhagic types, is challenging. Whether very early blood-pressure control in the ambulance improves outcomes among patients with undifferentiated acute stroke is uncertain.

Methods: We randomly assigned patients with suspected acute stroke that caused a motor deficit and with elevated systolic blood pressure (≥150 mm Hg), who were assessed in the ambulance within 2 hours after the onset of symptoms, to receive immediate treatment to lower the systolic blood pressure (target range, 130 to 140 mm Hg) (intervention group) or usual blood-pressure management (usual-care group).

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