Key result
Integrated BP self-monitoring proves feasible in stroke or TIA patients with ~93% trial completion.
Why the study?
Optimising blood pressure control is crucial for preventing subsequent stroke, but the feasibility and potential effectiveness of blood pressure self-monitoring with planned medication titration needed evaluation in patients with prior stroke or TIA.
Does blood pressure self-monitoring with planned medication titration improve blood pressure control and prove feasible in patients with a previous stroke or TIA?
RCT (n=15)
Open-label
2:1
Yes
Does blood pressure self-monitoring with planned medication titration improve blood pressure control and prove feasible in patients with a previous stroke or TIA?
Absolute Event Rate: 120.8% vs 140.5%
An integrated blood pressure self-monitoring intervention with planned medication titration is feasible, acceptable, and safe to deliver in primary care for patients post-stroke or TIA.
Supports primary care delivery post-stroke/TIA; extends feasibility data but leaves efficacy on BP control open for larger trials.
Background Optimising blood pressure (BP) control is one of the most important modifiable risk factors in preventing subsequent stroke where the risk increases by one-third for every 10 mmHg rise in systolic BP. This study evaluated the feasibility and potential effectiveness of blood pressure self-monitoring with planned medication titration, to inform a definitive trial of the intervention, in patients with a previous stroke or transient ischaemic attack (TIA). Methods Patients with a history of stroke/TIA and sub-optimal BP control were invited to take part in a mixed methods feasibility study for a randomised controlled trial. Those meeting the inclusion criteria with systolic BP >130 mmHg were randomised to a self-monitoring intervention group or usual care group. The intervention involved self-monitoring BP twice a day for 3 days within a 7-day period, every month, following text message reminders. Treatment escalation, based on a pre-agreed plan by the general practitioner (GP) and patient, was initiated according to the results of these readings. Semi-structured interviews were carried out with patients and clinicians and analysed thematically. Results Of those identified, 47% (32/68) attended for assessment. Of those assessed, 15 were eligible for recruitment and were consented and randomised to the intervention or control group on a 2:1 basis. Of those randomised, 93% (14/15) completed the study and there were no adverse events. Systolic BP was lower in the intervention group at 3 months. Participants found the intervention acceptable and easy to use. GPs found it easy to incorporate into their practice activity without increasing workload. Conclusions TASMIN5S, an integrated blood pressure self-monitoring intervention in patients with a previous stroke/TIA, is feasible and safe to deliver in primary care. A pre-agreed three-step medication titration plan was easily implemented, increased patient involvement in their care, and had no adverse effects. This feasibility study provides important information to inform a definitive trial to determine the potential effectiveness of the intervention in patients post-stroke or TIA. Trial registration ISRCTN57946500 . Registered on 12/08/2019.
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Doogue et al. (2023) conducted an RCT in Previous stroke or transient ischaemic attack (TIA) (n=15). Blood pressure self-monitoring with planned medication titration (TASMIN5S) vs. Usual care was evaluated on Post-trial systolic blood pressure at 3 months (mmHg). An integrated blood pressure self-monitoring intervention with planned medication titration was feasible and acceptable in patients with a previous stroke or TIA, with 93% completing the 3-month trial.
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