Abstract
Measuring blood pressure (BP) at home and remote monitoring can improve the patient's adherence to BP control and vascular outcomes. This study evaluated the feasibility of a trial regarding the effects of an intensive mobile BP management strategy versus usual care in acute ischemic stroke patients. A feasibility-testing, randomized, open-labeled controlled trial was conducted. Remote BP measurement, data transmission, storage, and centralized monitoring system were organized through a Bluetooth-equipped sphygmomanometer paired to the participants' smartphones. Participants were randomized equally into intensive management (behavioral intensification to measure BP at home by texting, direct telephone call, or breakthrough visit) and control (usual care) groups. The primary feasibility outcomes were: 1) recruitment time for the pre-specified number of participants, 2) retention of participants, 3) frequency of breakthrough visit calls, 4) response to breakthrough visit call, and 5) proportions satisfying BP measurement criteria. Sixty participants were randomly assigned to the intensive management (n = 31) and control (n = 29) groups, of which 57 participants were included in the primary analysis with comparable baseline characteristics. Recruitment time from the first to the last participant was 350 days, and 95% of randomized participants completed the final visit (intensive, 94%; control, 98%). Eight breakthrough visit calls were made to 7 participants (23%), with complete and immediate responses within 3 ± 4 days. The median of half-day blocks fulfilling the BP measurement criteria per patient were 91% in the intensive group and 83% in the control group (difference, 12.2; 95% confidence interval, 2.2-22.2). No adverse events related to the trial procedures were reported. The intensive monitoring, including remote BP measurement, data transfer, and centralized monitoring system, engaged with behavioral intensification was feasible if the patients complied with the intervention. However, the device utilized would need further improvement prior to a large trial.
Highlights
Achieving and maintaining the target blood pressure (BP) in an individual would be one of the top priorities in preventing further vascular events after an ischemic stroke [1]
Sixty ischemic stroke patients hospitalized in the three participating centers were randomly assigned to the intensive management group (n = 31; 52%) and the control group (n = 29; 48%)
Hypertension was diagnosed in 46 participants (21 [68%] and 25 [86%] in the intensive management group and control group, respectively), and antihypertensive medication before the index stroke was prescribed in 27 participants (12 [39%] and 15 [52%] in the intensive management group and control group, respectively)
Summary
Achieving and maintaining the target blood pressure (BP) in an individual would be one of the top priorities in preventing further vascular events after an ischemic stroke [1]. Sophisticated BP control is feasible with various antihypertensive medications in the market, but there are still unanswered questions related to BP management. Most of the current scientific reports are based on the office-measured BP, which is allegedly higher than home-measured BP [2]. Home-measured BP would be a better indicator reflecting the levels and fluctuations of BP in daily life, but scientific hurdles still exist including measurement, transfer, monitoring, and interpretation of remotely assessed BP, as well as subsequent pharmacological modifications. Medication adherence is vital to maintain adequate BP control, but amost half of the hypertensive patients discontinue recommended medications within a year [3]. Clinical questions regarding BP variability would be answered better through remote collection of frequent home BP measurements than standard office BP measurements
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