Antihypertensive Medication in Suspected Stroke Patients in Pre-Hospital Settings in United States (P02.197)

Abstract

Objective: We performed this study to determine the frequency and patterns of use of parentral antihypertensive agents with EMS settings. Acute hypertensive response has been observed in a large percentage of stroke patients. Background Pre-hospital initiation of antihypertensive agents may be advantageous or deleterious in stroke patients. Design/Methods: We analyzed the data related to the EMS transport of 101,478 stroke patients from in the 2009 National Emergency Medical Services Information System (NEMSIS) Research Dataset, from 26 states in the US.From this dataset we identified medication codes, transport time, and the geographic nature of each EMS dispatch. The transport time and geographic nature of each call was considered relevant as the time of transport will impact EMS provider9s ability to initiate parenteral antihypertensive treatment and the ability of the treatment to have significant impact on the patient9s blood pressure (BP) prior to ED arrival. Results: We found 120 unique medication codes associated with these patients. Overall, 10 agents were administered to 1.9% (1,903/101,478) of the suspected stroke patients in the database. The number of times each agent (number of patients; frequency) was used as follows: Clonidine (1-.00%), Diltiazem (94 –4.9%), Enalapril (1-.00%), Hydralazine (1-.00%), Labatelol(219 – 11.5%),Metroprolol (80 – 4.2%), Nicardipine (14 - .7%), Nifedipine (1 - .00%), Nitroglycerin (1466 – 77%), and Nitroprusside (26 – 1.4%). The mean transport time was 15.7 minutes and the mean scene time was 17.2 minutes. The EMS dispatches occurred within four geographic groups with the following frequencies: rural (10.05%), suburban (10.22%), urban (77.03%), wilderness (2.70%). Conclusions: Although the use of antihypertensive medication in suspected stroked patients in the EMS setting is infrequent and not standardized, the mean scene and transport time provide a sufficient interval to allow for the initiation of IV antihypertensive medication in these patients. Disclosure: Dr. Anderson has nothing to disclose.