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RAPID INTERVENTION WITH GLYCERYL TRINITRATE IN HYPERTENSIVE STROKE TRIAL-2 (RIGHT-2): SAFETY AND EFFICACY OF TRANSDERMAL GLYCERYL TRINITRATE, A NITRIC OXIDE DONOR
  1. Philip M W Bath1,
  2. Mark Dixon1,
  3. Jason Appleton1,
  4. Polly Scutt1,
  5. Timothy England1,
  6. Hayley Foster1,
  7. Harriet Howard1,
  8. Malcolm Jarvis2,
  9. Alan Montgomery1,
  10. Stuart Pocock3,
  11. John Potter4,
  12. Christopher Price5,
  13. Tom Robinson6,
  14. Christine Roffe7,
  15. A Niro Siriwardena8,
  16. Nikola Sprigg1,
  17. Joanna Wardlaw9
  1. 1Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
  2. 2Private Representative, Nottingham, UK
  3. 3Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Norwich Medical School, University of East Anglia, Norwich, UK
  5. 5The Medical School, University of Newcastle, Newcastle, UK
  6. 6Department of Cardiovascular Sciences, University Hospital of Leicester, Leicester, UK
  7. 7Institute of Science and Technology in Medicine, Keele University, Keele, UK
  8. 8School of Health and Social Care, University of Lincoln, Lincoln, UK
  9. 9Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK

Abstract

Rationale High blood pressure (BP) is common in acute stroke and is associated with poor outcome. Previous hospital-based trials testing the effects of BP lowering on functional outcome have been inconclusive. The PIL-FAST and RIGHT pilot trials confirmed the feasibility of performing single-centre ambulance-based stroke trials in the UK. In both RIGHT and a subgroup of patients recruited within 6 hours into the large ENOS trial, transdermal glyceryl trinitrate (GTN), a nitric oxide donor, lowered BP and reduced death or disability. Based on these results, RIGHT-2 aims to test the safety and efficacy of transdermal GTN in the pre-hospital setting.

Methods Paramedics from 7 UK ambulance services serving 40 comprehensive or primary stroke care centres will screen, consent, randomise and treat 850 patients presenting within 4 hours of FAST-positive stroke and with systolic BP >120 mm Hg. Treatment will comprise GTN or similar sham patch, and will be continued in hospital for 3 days. The primary outcome will be the modified Rankin Scale at day 90. Secondary outcomes include vascular events, disability, quality of life, mood and cognition. Neuroimaging and biomarkers will examine potential mechanisms of action.

Status Recruitment commenced in October 2015. Challenges with the trial and baseline characteristics of the first recruited patients will be presented.

Funding British Heart Foundation.

  • prehospital care

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