Can glyceryl trinitrate improve outcomes after a stroke?

Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2): Assessment of safety and efficacy of transdermal glyceryl trinitrate, a nitric oxide donor, and of the feasibility of a multicentre ambulance-based stroke trial

Philip Bath (lead researcher)

Nottingham,University of

Start date: 01 May 2015 (Duration 3 yrs)

High blood pressure is common in people who have a stroke because of a blood clot or a bleed – called ischaemic or haemorrhagic stroke – and people are more likely to die or become disabled because of it. So far trials to lower blood pressure in people with stroke have taken place but have produced mixed results, partly because blood pressure treatments have been tested too late.

Previous trials have suggested that when given very early on after a stroke, a drug called glyceryl trinitrate (GTN), which is currently used to treat angina, can lower blood pressure and improve outcomes. Professor Philip Bath and colleagues at the University of Nottingham have been awarded a grant from the BHF to carry out a larger clinical trial called RIGHT-2 to confirm if this is true, and if GTN used in these circumstances is safe.

850 patients from five areas around the UK who have had a stroke in the last four hours, and who have high blood pressure, will be recruited to the trial by the paramedics before they are admitted to one of 30 stroke hospitals around the country. Paramedics will take consent from the patient or relative, and then the patient will be allocated to either receive GTN given in a skin patch or a dummy skin patch.

All patients will be treated for four days, and some patients will have their brain blood flow assessed as well. This will help the researchers find out how the drug is working using neuroimaging and blood tests. The patients will be assessed again after ninety days, when the researchers will record the outcome – including whether the patient has died, if they are disabled, and what their quality of life and mood is like.

If this trial is successful and finds that GTN can reduce death and dependency, it could reveal a new, simple way for paramedics to routinely treat patients with presumed stroke. This research could change the way we treat people who have had a stroke.

Project details

Grant amount £1,370,708
Grant type Clinical Study
Start Date 01 May 2015
Duration 3 yrs
Reference CS/14/4/30972
Status In progress

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