Lowering Blood Pressure in Stroke Patients in the Ambulance — A Bridge Too Close?

In The Prince, Niccolò Machiavelli wrote, "[W]ith those hectic fevers, as the doctors say, … at their beginning [they] are easy to cure but difficult to recognize, but in the course of time… [they] become easy to recognize but difficult to cure."1 As with Renaissance politics, so with stroke; time plays a critical role in diagnosis and treatment. Since 2008, the investigators in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) have been incrementally replacing opinion with evidence regarding the treatment of hypertension in patients with spontaneous intracerebral hemorrhage diagnosed by brain computed tomography (CT).2 Their current . . .