Rapid intervention with glyceryl trinitrate in hypertensive stroke Trial-2 (Right-2): safety and efficacy of transdermal glyceryl trinitrate, a nitric oxide donor

Bath, Philip M. W. and Dixon, Mark and Appleton, Jason and Scutt, Polly and England, Timothy and Foster, Hayley and Howard, Harriet and Jarvis, Malcolm and Montgomery, Alan and Pocock, Stuart and Potter, John and Price, Christopher and Robinson, Tom and Roffe, Christine and Siriwardena, A. Niroshan and Sprigg, Nikola and Wardlaw, Joanna (2016) Rapid intervention with glyceryl trinitrate in hypertensive stroke Trial-2 (Right-2): safety and efficacy of transdermal glyceryl trinitrate, a nitric oxide donor. Emergency Medicine Journal, 33 . e13-e14. ISSN 1472-0205

Full content URL: https://emj.bmj.com/content/33/9/e13.2

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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
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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.

Additional Information:Presented as a poster presentation at the 999 EMS Research Forum Conference 2016: Making It Happen: Delivering Research in Pre-hospital Care. The Assembly Rooms, Fenkle Street, Newcastle, NE1 5XU, Tuesday 1st March 2016,
Keywords:Emergency Medical Systems, ambulance services, hypertension, stroke, glyceryl trinitrate, RIGHT-2, pre-hospital, NotOAChecked
Subjects:B Subjects allied to Medicine > B990 Subjects Allied to Medicine not elsewhere classified
A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Social Science > School of Health & Social Care
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ID Code:25307
Deposited On:07 Dec 2016 15:36

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