Please select the eligibility criteria that correspond to the clinical trial below.
Title: Paramedic Initiated Lisinopril For Acute Stroke Treatment: a Pilot Randomised Controlled Trial
Brief Summary: This study aims to investigate the use of lisinopril to lower blood pressure in stroke patients, pre-hospital, by research-trained paramedics.


Options:
A: Inclusion criteria:

Male or female subjects 55 year or older who have suffered an ischemic stroke within the past 90 days and who meet all other inclusion criteria. Include also patients of ages 50 - 54 years and/or 90 to 120 days after the qualifying stroke provided the patient has at least two of the following additional risk factors:

* Diabetes mellitus
* Hypertension (systolic BP ¿ 140 or diastolic BP ¿ 90)
* Smoker at time of qualifying stroke
* Obesity (BMI\>30; BMI=weight (kg)/\[height (m)\]2)
* Previous vascular disease (stroke, MI, or peripheral arterial disease prior to qualifying stroke)
* End-organ-damage (retinopathy, LVH, or microalbuminuria)
* Hyperlipidemia

Exclusion criteria:

hemorrhagic stroke (must be ruled out by imaging);unable to give informed consent; known brain tumor, severe renal or hepatic insufficiency, current active peptic ulcer disease, severe coronary artery disease including unstable angina pectoris or an MI within the previous 3 months,or history of a hemostatic disorder or systemic bleeding ;hyperkalemia;uncorrected volume or sodium depletion; pre-stroke history of dementia;modified Rankin score greater than 4;qualifying stroke induced by surgical or cardiovascular procedure;uncontrolled hypertension at entry above 180/110 mmHg (goal BPs are lower); SBP 120 mmHg or less for hospitalized patients; currently taking an ARB and not able or willing to switch to alternative; required or planned continuing treatment with antithrombotics or anticoagulants including heparin or warfarin or non-study platelet inhibitors; syndrome of asthma, rhinitis and nasal polyps;scheduled for major surgery, carotid endarterectomy, or carotid angioplasty (4 weeks post surgery is allowed);unlikely to be released from hospital following the qualifying stroke or presence of a severe disability likely to lead to being bedridden or demented or a non-vascular disease or condition which makes it unlikely that the patient will survive to the end of the trial; history of thrombocytopenia or neutropenia.
B: Inclusion Criteria:

* Patients with CT-confirmed spontaneous Intracerebral Haemorrhage (ICH)
* Elevated systolic blood pressure (\>150mmHg and \<220mmHg)
* Capacity to commence randomly assigned treatment within 6 hours of onset of ICH.
* Able to be 'actively' treated and admitted to a monitored facility

Exclusion Criteria:

* Clear indication or contraindication to intensive BP lowering.
* Evidence ICH secondary to a structural abnormality
* Use of thrombolytic agent
* Previous ischaemic stroke within 30 days
* A very high likelihood that the patient will die within the next 24 hours on the basis of clinical and/or radiological criteria
* Score of 3-5 on the Glasgow Coma Scale (indicating deep coma)
* Significant pre-stroke disability or advanced dementia
* Planned early neurological intervention
* Participation in another clinical trial.
* A high likelihood that the patient will not adhere to the study treatment and follow-up regimen.
C: 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
D: Inclusion Criteria:

* Age ≥22 years
* Ischemic stroke onset within 48 hours confirmed by imaging (CT scan or MRI) study
* Systolic BP≥140 and \<220 mm Hg and diastolic BP≥80 mm Hg
* No contraindications to antihypertensive treatment
* Able and willing to sign informed consent by patients or their direct family members

Exclusion Criteria:

* Individuals with hemorrhagic stroke
* Individuals with severe heart failure (NY Heart Association class III and IV), myocardial infarction, unstable angina, aortic dissection and cerebrovascular stenosis
* Individuals in a deep coma
* Individuals with resistant hypertension \[systolic BP ≥170 mm Hg despite use of 4 or more antihypertensive medications for half a year or longer\]
* Intravenous thrombolytic therapy (such as intravenous rtPA)
* Individuals who are unable to participate in follow-up examination
* Current pregnant women

Answer: C