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

Episode 909: Prehospital Blood Pressure Management in Suspected Stroke

Emergency Medical Minute