Researchers at The University of Nottingham have been awarded funding from the British Heart Foundation to carry out a clinical trial to use medicated skin patches to lower blood pressure quickly after a suspected stroke, before the patient gets to hospital.
The study follows a large international trial called ENOS (Efficacy of Nitric Oxide in Stroke), led from Nottingham, which indicated that early treatment with skin patches containing blood-pressure-lowering glyceryl trinitrate (also known as nitroglycerine) had a beneficial effect on a patient’s recovery, depending on the type of stroke suffered.
When stroke strikes
There are around 152,000 people who suffer a stroke every year in the UK according to the Stroke Association. Some treatment is only effective if given within a short period of time after the event and this early intervention can limit the severity of the symptoms and longer term effects of the stroke.
Leading the new RIGHT-2 (Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2) study, Professor Philip Bath, said: “This new trial is a logical extension of our previous studies which suggested that the earlier a patient was given glyceryl trinitrate, the better their chances of a full recovery from stroke. We are very grateful for the cooperation of UK Ambulance Services, including the East Midlands Ambulance Service (EMAS) who are coordinating the ambulance part of the trial, whose paramedics will lead on identifying patients who are suspected of having a stroke. More than 30 hospitals, including Nottingham University Hospitals’ Trust, will care for the patients once they arrive and help with follow up.”
Intervention on the move
The trial aims to recruit 850 patients over the next three years and paramedics will administer the first dose of the treatment either in the patient’s home or in the ambulance. Patients who agree to take part when they are first taken ill will be randomly selected to receive either a 5mg glyceryl trinitrate skin patch, repeated over three more days, or a blank skin patch, but they will not know which they are given.
Follow-ups will be carried out by telephone three months and one year after their stroke to determine the patient’s recovery. In addition to lowering blood pressure, the patches may open up blood vessels in the brain to improve blood flow, and may help brain cells survive the stress of reduced blood flow.
Potential new protocols
Niro Siriwardena, Associate Medical Director of East Midlands Ambulance Service, said: “In the RIGHT-2 trial ambulance services are at the forefront of cutting edge research into treatment of stroke. Following a positive feasibility study at EMAS, this major trial will provide new evidence for paramedic treatment of stroke, with potential to change treatment protocols worldwide.”
Jeremy Pearson, Associate Medical Director at the British Heart Foundation (BHF), said: “The BHF funds research into stroke as well as heart disease because the main cause (blocking of small blood vessels in the brain or the heart with a clot) and the main risk factors are the same. Current treatment for stroke includes the use of clot-busting drugs, but unless used quickly their effect is limited. This new trial will use a simple treatment that can be applied rapidly by paramedics as soon as they reach the patient, with the hope that by intervening as quickly as possible patient outcomes can be improved.”
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Notes to editors: The University of Nottingham has 43,000 students and is ‘the nearest Britain has to a truly global university, with campuses in China and Malaysia modelled on a headquarters that is among the most attractive in Britain’ (Times Good University Guide 2014). It is also one of the most popular universities in the UK among graduate employers and the winner of ‘Research Project of the Year’ at the THE Awards 2014. It is ranked in the world’s top one per cent of universities by the QS World University Rankings, and 8th in the UK by research power according to REF 2014.
The University of Nottingham in Malaysia (UNMC) is holding events throughout 2015 to celebrate 15 years as a pioneer of transnational education. Based in Semenyih, UNMC was established as the UK’s first overseas campus in Malaysia and one of the first world-wide.
About the British Heart Foundation
For over 50 years the British Heart Foundation has pioneered research that’s transformed the lives of people living with heart and circulatory conditions. Our work has been central to the discoveries of vital treatments that are changing the fight against heart disease. But so many people still need our help. From babies born with life-threatening heart problems to the many Mums, Dads and Grandparents who survive a heart attack and endure the daily battles of heart failure. Join our fight for every heartbeat in the UK. Every pound raised, minute of your time and donation to our shops will help make a difference to people’s lives. For more information visit www.bhf.org.uk
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