Episode 909: Prehospital Blood Pressure Management in Suspected Stroke

Contributor: Aaron Lessen MD

Educational Pearls:

• A recent study assessed EMS treatment of high blood pressure in the field

• 2404 patients randomized to prehospital treatment (1205)  vs. usual care (1199)

• Included patients with prehospital BP greater than 150 mm Hg

• The treatment arm's BP goal was 130-140 mm Hg

• The primary efficacy outcome was functional status 90 days out

• Stroke was confirmed by imaging upon hospital arrival

• On arrival, the mean SBP of the treatment arm was 159 mm Hg compared with 170 mm Hg in the usual care group

• No significant difference in functional outcomes between the treatment group and the usual care group (Common Odds Ratio of 1.00, 95% CI = 0.87-1.15)

• Post-imaging analysis revealed 46.5% of the undifferentiated patients had a hemorrhagic stroke

• Prehospital reduction in BP did reduce the odds of poor functional outcome in hemorrhagic stroke patients alone (Common Odds Ratio 0.75, 95% CI 0.60-0.92)

• Those with ischemic stroke had increased odds of poor functional outcome (Common Odds Ratio 1.30, 95% CI 1.06-1.60)

• Bottom line: it is challenging to identify the stroke type in the prehospital setting and therefore not necessarily helpful to treat the blood pressure

References

1. Ren X, Zhang C, Xu P, et al. Intensive Ambulance-Delivered Blood- Pressure Reduction in Hyperacute Stroke. New England Journal of Medicine. 2024;390(20):1862-1872. doi:10.1056/NEJMoa2314741

Summarized by Jorge Chalit, OMSIII | Edited by Meg Joyce & Jorge Chalit