Key result
Blood pressure telemonitoring in stroke and TIA survivors was feasible and resulted in a mean reduction of 10.1 mmHg in systolic ambulatory blood pressure compared to 3.8 mmHg with usual care.
Why the study?
Does blood pressure telemonitoring reduce daytime ambulatory systolic blood pressure in stroke or TIA survivors with uncontrolled blood pressure?
RCT (n=55)
Single-blind
3:1
Yes
Does blood pressure telemonitoring reduce daytime ambulatory systolic blood pressure in stroke or TIA survivors with uncontrolled blood pressure?
Absolute Event Rate: 10.1% vs 3.8%
A pilot trial demonstrated that blood pressure telemonitoring is feasible, well-accepted, and potentially effective for reducing systolic blood pressure in stroke and TIA survivors.
May support telemonitoring for post-stroke BP control; extends prior hypertension RCTs to this high-risk population.
BACKGROUND: Good blood pressure (BP) control reduces the risk of recurrence of stroke/transient ischaemic attack (TIA). Although there is strong evidence that BP telemonitoring helps achieve good control, none of the major trials have considered the effectiveness in stroke/TIA survivors. We therefore conducted a feasibility study for a trial of BP telemonitoring for stroke/TIA survivors with uncontrolled BP in primary care. METHOD: Phase 1 was a pilot trial involving 55 patients stratified by stroke/TIA randomised 3:1 to BP telemonitoring for 6 months or usual care. Phase 2 was a qualitative evaluation and comprised semi-structured interviews with 16 trial participants who received telemonitoring and 3 focus groups with 23 members of stroke support groups and 7 carers. RESULTS: Overall, 125 patients (60 stroke patients, 65 TIA patients) were approached and 55 (44%) patients were randomised including 27 stroke patients and 28 TIA patients. Fifty-two participants (95%) attended the 6-month follow-up appointment, but one declined the second daytime ambulatory blood pressure monitoring (ABPM) measurement resulting in a 93% completion rate for ABPM - the proposed primary outcome measure for a full trial. Adherence to telemonitoring was good; of the 40 participants who were telemonitoring, 38 continued to provide readings throughout the 6 months. There was a mean reduction of 10.1 mmHg in systolic ABPM in the telemonitoring group compared with 3.8 mmHg in the control group, which suggested the potential for a substantial effect from telemonitoring. Our qualitative analysis found that many stroke patients were concerned about their BP and telemonitoring increased their engagement, was easy, convenient and reassuring. CONCLUSIONS: A full-scale trial is feasible, likely to recruit well and have good rates of compliance and follow-up. TRIAL REGISTRATION: ISRCTN61528726 15/12/2011.
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Hanley et al. (2015) conducted an RCT in Stroke or Transient Ischaemic Attack (TIA) with uncontrolled blood pressure (n=55). Blood pressure telemonitoring vs. Usual care was evaluated on Reduction in daytime ambulatory systolic blood pressure (ABPM). Blood pressure telemonitoring in stroke and TIA survivors was feasible and resulted in a mean reduction of 10.1 mmHg in systolic ambulatory blood pressure compared to 3.8 mmHg with usual care.
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