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Hypertension is common with acute stroke, but the optimal strategy for managing high blood pressure in the hyperacute prehospital setting is unclear. RIGHT-2 failed to demonstrate improvements in 90-day functional outcomes with a paramedic-administered transdermal antihypertensive compared with sham treatment for patients with suspected stroke within 4 hours after symptom onset and with systolic blood pressure ≥120 mm Hg. A similar trial, MR ASAP, which enrolled probable stroke patients within 3 hours of symptom onset and systolic blood pressure ≥140 mm Hg, was terminated prematurely due to safety concerns in patients with intracerebral hemorrhage.
Now, the results of the largest trial of hyperacute blood-pressure lowering for acute stroke t…