About this trial
Stroke is the third most common cause of death worldwide and the leading cause of disability. High blood pressure is an important risk factor for stroke. Lowering a person's blood pressure reduces the risk of future stroke or heart attack, and current guidelines recommend treatment to a target of \<130mmHg for secondary prevention.
Home blood pressure measurement and telemonitoring are acceptable to patients, but there is uncertainty over the use of out of office blood pressure measurements in stroke patients in guidelines.
This is a study designed to establish the feasibility of a larger clinical trial, comparing home blood pressure monitoring, telemonitoring and medication titration with standard care. The study hypothesis is that home BP measurement and telemonitoring with medication titration may lead to improved BP control compared to standard of care clinical practice.
Eligibility criteria
Qualifiers
Age ≥40
Ischaemic stroke1, high-risk TIA, proven by imaging (brain CT/MRI)
Living at home and independent (walking without the aid of another person, but may have some help for daily activities)
SBP≥140mmHg at entry (average of 2 measures, seated, in the same arm, after resting alone in office for 10 minutes)
Disqualifiers
SBP <110mmHg after 3 minutes of standing or other contra-indication to intensive SBP lowering in opinion of treating clinician (eg. Orthostatic symptoms, syncope or pre syncope, recurrent falls)
Qualifying stroke due to intracerebral haemorrhage (ICH), cardio-embolism or other defined causes (eg. dissection, endocarditis, other specified)
Severe stenosis or occlusion of large cranio-cervical artery (>70% stenosis/occlusion of cervical carotid, vertebral, or Circle of Willis artery)
Unlikely to comply with study procedures due to severe or fatal comorbid illness (eg. dementia, active malignancy, severe frailty) or other factor (eg. inability to travel)
Trial design
Treatments tested in this trial
- anti-hypertensive, home blood pressure measurement, telemonitoring and medication titration
- Standard of Care Blood Pressure Management with Antihypertensives
Treatment groups
Sponsors and collaborators
University College Dublin
Lead sponsor
St Vincent's University Hospital, Ireland
Collaborator
Cork University Hospital
Collaborator
Tallaght University Hospital
Collaborator
HRB Stroke Trials Network Ireland
Collaborator
National University of Ireland, Galway, Ireland
Collaborator
Mater Misericordiae University Hospital
Collaborator
St. James's Hospital, Ireland
Collaborator
Connolly Hospital Blanchardstown
Collaborator