Home blood pressure monitoring with nurse-led telephone support did not significantly reduce systolic blood pressure compared to usual care in patients with a history of stroke (adjusted MD 0.3 mm Hg).
RCT (n=381)
Open-label
Computer-generated stratified randomization
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Does home blood pressure monitoring with nurse-led telephone support reduce systolic blood pressure in patients with hypertension and a history of stroke?
Home blood pressure monitoring with nurse-led telephone support did not significantly reduce systolic blood pressure compared to usual care in patients with hypertension and prior stroke.
Estimación del efecto: Adjusted MD 0.3 (95% CI -3.6 to 4.2)
Tasa de eventos absoluta: 1.7% vs -0.7%
BACKGROUND: Adequate control of blood pressure reduces the risk of recurrent stroke. We conducted a randomized controlled study to determine whether home blood pressure monitoring with nurse-led telephone support would reduce blood pressure in patients with hypertension and a history of stroke. METHODS: We recruited 381 participants (mean age 72 years) from outpatient and inpatient stroke clinics between Mar. 1, 2007, and Aug. 31, 2009. Nearly half (45%, 170) of the participants had some disability due to stroke. Participants were visited at home for a baseline assessment and randomly allocated to home blood pressure monitoring (n = 187) or usual care (n = 194). Those in the intervention group were given a monitor, brief training and telephone support. Participants who had home blood pressure readings consistently over target (target < 130/80 mm Hg) were advised to consult their family physician. The main outcome measure was a fall in systolic blood pressure after 12 months, measured by an independent researcher unaware of group allocation. RESULTS: Despite more patients in the intervention group than in the control group having changes to antihypertensive treatment during the trial period (60.1% 98/163 v. 47.6% 78/164, p = 0.02), the fall in systolic blood pressure from baseline did not differ significantly between the groups (adjusted mean difference 0.3 mm Hg, 95% confidence interval -3.6 to 4.2 mm Hg). Subgroup analysis showed significant interaction with disability due to stroke (p = 0.03 at 6 months) and baseline blood pressure (p = 0.03 at 12 months). INTERPRETATION: Overall, home monitoring did not improve blood pressure control in patients with hypertension and a history of stroke. It was associated with a fall in systolic pressure in patients who had uncontrolled blood pressure at baseline and those without disability due to stroke. TRIAL REGISTRATION: ClinicalTrials.gov registration NCT00514800.
Kerry et al. (Mon,) conducted a rct in Hypertension and history of stroke (n=381). Home blood pressure monitoring with nurse-led telephone support vs. Usual care was evaluated on Fall in mean systolic blood pressure from baseline (Adjusted MD 0.3, 95% CI -3.6 to 4.2). Home blood pressure monitoring with nurse-led telephone support did not significantly reduce systolic blood pressure compared to usual care in patients with a history of stroke (adjusted MD 0.3 mm Hg).