Abstract Body: Background: Uncontrolled high blood pressure is a risk factor for acute stroke and a predictor of poor stroke outcomes. Less is known about the efficacy and safety of early ambulance-delivered blood pressure reduction on clinical and functional outcomes in patients with undifferentiated acute stroke.

Methods: PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials that compared intervention (with glyceryl trinitrate) to usual blood pressure care or sham in patients with undifferentiated acute stroke; the outcomes of day 90 modified Rankin scale (mRS) maximum score of 6, EuroQol-5D score, National Institutes of Health Stroke Scale (NIHSS ) score at hospital admission, death within 90 days, Barthel index at 90 days, and home time. Heterogeneity was examined using I² statistics.

Results: We included 3 RCTs with 3547 Patients, of whom 388 received intervention with glyceryl trinitrate. The pooled results of the included 3 RCTs comparing Intervention with glyceryl trinitrate to usual care or sham treatment showed that the death within 90 days (21.9% vs 21.1% respectively; OR = 1.05; 95% CI [0.89, 1.24]; I² = 0%; p = 0.546), EuroQol-5D-5L score (MD = -0.00; 95% CI [-0.03, 0.03]; I² = 0%; p = 0.98), NIHSS score at hospital admission (MD = 0.18; 95% CI [-0.70, 1.06]; I² = 0%; p = 0.69), day 90 mRS maximum score at 6 (MD = 0.01; 95% CI [-0.25, 0.27]; I² = 0%; p = 0.94), NIHSS score at 24 hours (MD = 0.56; 95% CI [-0.16, 1.27]; I² = 0%; p = 0.13), Barthel index at 90 days (MD = -2.56; 95% CI [-7.90, 2.78]; I² = 0%; p = 0.35), and home time (MD = 0.22 days; 95% CI [-5.02, 5.46]; I² = 0%; p = 0.93) were not statistically different between the intervention and the usual care groups.

Conclusion: These findings suggest that early ambulance-delivered blood pressure reduction does not have superior efficacy and safety profiles for clinical and functional outcomes compared with usual care or sham treatment in patients with undifferentiated acute stroke.