Paramedic Initiated Lisinopril For Acute Stroke Treatment "PIL-FAST"


Phase 1 Results N/A

Eligibility Criteria

Inclusion Criteria

- Adults ≥ 40 years old
- New unilateral arm weakness thought to be due to acute stroke within 3 hours of symptom onset
- Hypertension as defined by systolic BP >160mm Hg on two consecutive seated or lying readings taken 5 - 10 minutes apart
- Conscious (eyes open spontaneously ie "A" on Alert, Voice, Pain, Unresponsive (AVPU) scale)
- Patient being transported to a PIL-FAST trial site (i.e. Royal Victoria Infirmary, North Tyneside General Hospital and Wansbeck General Hospital)
- Verbal consent obtained from participant or next of kin
Exclusion criteria:
- Age < 40 years
- Females who are pregnant, lactating or at risk of pregnancy (i.e. who are not surgically sterile or at least 1 year post last menstrual period). Females < 56 years of age consented by a relative will be excluded as menstrual history may be unknown.
- Any presentation of suspected stroke without unilateral arm weakness
- Cannot establish that stroke onset time (i.e. when patient was last seen well without symptoms) was within the last 3 hours
- Systolic BP < 160mm Hg
- Reduced level of consciousness (below "A" on AVPU scale)
- Patient not being transported to PIL-FAST trial site
- Absence of participant or next of kin consent
- Known to be taking ACE-inhibitor or Angiotensin II Receptor Blocker medication already
- Known sensitivity to lisinopril or other ACE-inhibitor medication
- Pulse > 120 beats per minute
- Seizure activity in this illness episode (witnessed or history)
- Hypoglycaemia (blood glucose < 3.5 mmols/l)
- Cannot walk independently prior to stroke (walking stick / frame is allowed)
- Obvious understanding or memory problems when next of kin is absent
- Significant head trauma or brain surgery in the last 3 months
- Known renal failure
- Known liver failure (or currently jaundiced)
- Uncontrolled heart failure (breathlessness at rest)
- Receiving palliative care for known malignancy
- Currently enrolled in a clinical trial assessing a study drug