The research presented at the 10th European Stroke Organisation Conference and published in the New England Journal of Medicine indicates that early identification of stroke type could be crucial in the effectiveness of in-ambulance blood pressure lowering treatment for patients with suspected acute stroke. Professor Craig Anderson, the lead investigator, highlighted the potential benefits of administering early blood pressure-lowering treatment to patients with intracerebral haemorrhage, the most deadly type of stroke. However, there were worsened outcomes in patients with a final diagnosis of ischaemic stroke, emphasizing the importance of accurate diagnosis for the success of early intervention.
The Intensive ambulance-delivered blood pressure reduction in hyper-acute stroke trial (INTERACT4) was a multicentre study conducted across ambulance services in China. The study involved 2404 patients with suspected acute stroke and elevated blood pressure, who were randomly assigned to receive immediate blood pressure-lowering treatment or standard care in hospital. Results showed that pre-hospital blood pressure reduction had benefits for patients with haemorrhagic stroke but negative effects for those with ischaemic stroke, leading to no significant overall difference in functional outcomes among stroke patients receiving early intervention.
Ischaemic stroke, caused by a blockage in a blood vessel leading to a loss of blood flow and neurological function, accounts for about 80% of strokes globally. On the other hand, intracerebral haemorrhage is a less common but more deadly type of stroke, with a higher mortality rate. The study results emphasize the time sensitivity of acute stroke treatments and the challenges of identifying the stroke type without brain imaging. While the study does not support in-ambulance blood pressure lowering treatment for all suspected stroke patients, it does suggest benefits for patients with haemorrhagic stroke.
With the introduction of mobile stroke ambulances equipped with diagnostic tools like CT scanners, there is potential for early identification and treatment of ischaemic strokes with clot-busting medication. However, until advancements in pre-hospital care are widespread, swift diagnosis and action upon arrival at the emergency department remain critical for preserving brain function in stroke patients. The study results highlight the need for tailored treatment approaches based on the stroke type and underscore the importance of early identification for optimizing outcomes in acute stroke patients.
In conclusion, the research presented at the European Stroke Organisation Conference suggests that early identification of stroke type is essential for the success of in-ambulance blood pressure lowering treatment in patients with suspected acute stroke. While the study showed benefits for patients with intracerebral haemorrhage, there were negative effects for those with ischaemic stroke, underscoring the importance of accurate diagnosis in early intervention. With advancements in pre-hospital care and the availability of diagnostic tools, there is potential for improved outcomes in stroke patients through timely treatment strategies tailored to the specific stroke type.
