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Randomized Trial of an Intervention to Improve Blood Pressure Control in Stroke Survivors.

ABSTRACT: Background: We conducted the first-of-its kind randomized stroke trial in Africa to test whether a THRIVES (Tailored Hospital-based Risk reduction to Impede Vascular Events after Stroke) intervention improved blood pressure (BP) control among patients with stroke.

Methods and results: Intervention comprised a patient global risk factor control report card, personalized phone text-messaging, and educational video. Four hundred patients recruited from 4 distinct medical facilities in Nigeria, aged ?18 years with stroke-onset within one-year, were randomized to THRIVES intervention and control group. The control group also received text messages, and both groups received modest financial incentives. The primary outcome was mean change in systolic BP (SBP) at 12 months. There were 36.5% females, 72.3% with ischemic stroke; mean age was 57.2±11.7 years; 93.5% had hypertension and mean SBP was 138.33 (23.64) mm?Hg. At 12 months, there was no significant difference in SBP reduction from baseline in the THRIVES versus control group (2.32 versus 2.01 mm?Hg, P=0.82). In an exploratory analysis of subjects with baseline BP >140/90 mm?Hg (n=168), THRIVES showed a significant mean SBP (diastolic BP) decrease of 11.7 (7.0) mm?Hg while control group showed a significant mean SBP (diastolic BP) decrease of 11.2 (7.9) mm?Hg at 12 months.

Conclusions: THRIVES intervention did not significantly reduce SBP compared with controls. However, there was similar significant decrease in mean BP in both treatment arms in the subgroup with baseline hypertension. As text-messaging and a modest financial incentive were the common elements between both treatment arms, further research is required to establish whether these measures alone can improve BP control among stroke survivors.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01900756.

SUBMITTER: Owolabi MO

PROVIDER: S-EPMC7139215 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Randomized Trial of an Intervention to Improve Blood Pressure Control in Stroke Survivors.

Owolabi Mayowa O MO Gebregziabher Mulugeta M Akinyemi Rufus O RO Akinyemi Joshua O JO Akpa Onoja O Olaniyan Olanrewaju O Salako Babatunde L BL Arulogun Oyedunni O Tagge Raelle R Uvere Ezinne E Fakunle Adekunle A Ovbiagele Bruce B

Circulation. Cardiovascular quality and outcomes 20191206 12

<h4>Background</h4>We conducted the first-of-its kind randomized stroke trial in Africa to test whether a THRIVES (Tailored Hospital-based Risk reduction to Impede Vascular Events after Stroke) intervention improved blood pressure (BP) control among patients with stroke.<h4>Methods and results</h4>Intervention comprised a patient global risk factor control report card, personalized phone text-messaging, and educational video. Four hundred patients recruited from 4 distinct medical facilities in ...[more]

PMID: 31805787

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Project description:Hypertension is a public health problem and a major risk factor for cardiovascular disease. The purpose of this study is to compare the effectiveness of a multidisciplinary program based on group and individual care versus group-only care, to promote blood pressure control in hypertensive patients in primary health care.Randomized controlled clinical trial. The study was conducted within the primary health care, in two units of the Family Health Strategy, covering 11,000 individuals, in Porto Alegre, Brazil. Two hundred and 56 patients, older than 40 years old and with uncontrolled hypertension, systolic blood pressure (BP) ?140 mmHg and/or diastolic BP ?90 mmHg or ?130 mmHg and/or diastolic BP ?80 mmHg for individuals with diabetes. Eligible patients were randomly assigned to a health care program aiming for blood pressure control, with the multidisciplinary program group or with the multidisciplinary program plus personalized care group. Primary outcome measures were reduction in systolic BP from baseline to 6 months. Secondary measures included proportion of patients with systolic or diastolic BP controlled. Student t test, Pearson's chi-squared test, Fisher's exact test, Mann-Whitney U test, Wilcoxon signed-ranks test and generalized estimating equation (GEE) model were used in the analysis.The baseline characteristics of participants were similar between groups. After 6 months of follow-up, systolic BP decreased markedly in both groups (? - 11.8 mmHg [SD, 20.2] in the multidisciplinary program group and ? - 12.9 mmHg [SD, 19.2] in the personalized care group; p?<?0.001). Similarly, we noted a significant change in diastolic BP over time in both groups (? - 8.1 mmHg [SD, 10.8] in the multidisciplinary program group and ? - 7.0 mmHg [SD, 11.5] in the personalized care group; p?<?0.001).The study demonstrates similar effectiveness of a group intervention in comparison to a personalized education program in hypertension patients to achieve BP control. These findings indicate that the intervention can be for all hypertensive patients assisted in primary health care.ClinicalTrials.gov Identifier NCT01696318 (May 2013).

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Randomized Trial of an Intervention to Improve Blood Pressure Control in Stroke Survivors.

Publications

Randomized Trial of an Intervention to Improve Blood Pressure Control in Stroke Survivors.

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