Objective: Prehospital reduction of blood pressure in the ambulance may decrease the odds of a poor functional outcome among patients with hemorrhagic stroke (ICH). Current practice for emergency medical service (EMS) providers in Maryland does not include administration of medications to treat blood pressure. Methods: This retrospective observational study identified ICH patients from a comprehensive stroke center database from February 1, 2019 to December 31, 2024 who were matched to prospectively collected data from the EMS system in Maryland, USA. Vital signs and time metrics were extracted from EMS dispatch to completion of hospital transfer. Primary outcomes were systolic blood pressure (SBP) and time metrics. Secondary outcomes were ICH volume and in-hospital mortality. We used generalized estimating equations for analyzing repeated measures data and logistic regression models. Results: A total of 303 patients transported by ambulance were included and 1121 SBP readings were analyzed. Mean age (SD) was 65(15) years and 53.8% were male. Current antihypertensive medication and antithrombotic medication use was 52% and 40%, respectively, and 15.5% of patients were on anticoagulants. Median time interquartile range from last known well to ambulance dispatch was 85.5 18-490 minutes. Time from dispatch to first SBP reading was 19 14-27 minutes. Total transport time was 55 43-72 min excluding 55 (18%) of patients who were transported from an outside hospital and had been started on intravenous antihypertensives in 69%. Median IQR, SD of first SBP was 172 149-200, 38.8 and 180.5 160–205, 36.9 mmHg in all and non-transferred patients, respectively. SBP was >150 mmHg in 221 (73%) patients on initial BP reading of which 44 (14.5%) had SBP≤150 mmHg at hospital arrival. Median number of BP readings per patient was 3 2-5 at an interval of 5 5–9 min. Initial ICH and IVH volume was 16 8-43 and 0 0-14 mL, respectively in 107 patients, and was not associated with SBP measurements. In-hospital mortality was 28% and was associated with SD of all SBP measures (OR 1.04; 95%CI: 1.002 - 1.07; p=0.03) in adjusted analysis. Conclusion: Pre-hospital SBP is frequently elevated above guideline recommendations in ICH patients with infrequent control in absence of medications. Total management time of almost 1 hour may offer an opportunity for improved BP control. High SBP variability but not absolute values was associated with in-hospital mortality.
Quinlan et al. (2026) studied this question.