Mixed methods feasibility study for a trial of blood pressure telemonitoring for people who have had stroke/transient ischaemic attack (TIA)

• Published in: Current controlled trials in cardiovascular medicine Vol. 16; no. 1; p. 117
• Main Authors: Hanley, Janet, Fairbrother, Peter, Krishan, Ashma, McCloughan, Lucy, Padfield, Paul, Paterson, Mary, Pinnock, Hilary, Sheikh, Aziz, Sudlow, Cathie, Todd, Allison, McKinstry, Brian
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25-03-2015; BioMed Central
• Subjects: Analysis; Blood pressure; Blood Pressure Monitoring, Ambulatory; Care and treatment; Data collection; Diagnosis; Disability; Family medicine; Feasibility Studies; Handicapped accessibility; Humans; Hypertension; Intervention; Ischemia; Ischemic Attack, Transient - physiopathology; Measurement; Methods; Mixed methods research; Monitoring systems; Patient outcomes; Patients; Pilot Projects; Primary care; Qualitative Research; Stroke; Stroke - physiopathology; Stroke patients; Surgery; Telemedicine; Transient ischemic attack; United Kingdom > UK; Scotland
• ISSN: 1745-6215; 1745-6215
• DOI: 10.1186/s13063-015-0628-y

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.
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.
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.
A full-scale trial is feasible, likely to recruit well and have good rates of compliance and follow-up.
ISRCTN61528726 15/12/2011.