Does telephone follow-up improve blood pressure after minor stroke or TIA?
BACKGROUND
hypertension is a common risk factor for stroke/transient ischaemic attack (TIA) and there is good evidence that blood pressure (BP) control prevents recurrent stroke. We investigated whether telephone follow-up (TFU) improved risk factor management in hypertensive patients after stroke/TIA.


METHODS
we conducted a randomised controlled trial and assigned hypertensive patients within 1 month of stroke or TIA to receive usual care (n = 27) or usual care plus regular TFU (n = 29). Primary outcome was the difference in 12 h ambulatory systolic BP change from baseline to 6 months (DeltaSBP) in both groups. TFU at 7 days, 1, 2 and 4 months included patient-focussed education and goal setting.


RESULTS
mean baseline BP was 145/83 mm Hg (standard deviation (SD) 21/14). There was no significant difference in DeltaSBP over 6 months with TFU. Median DeltaSBP was 0 mm Hg (interquartile range 19.5) in the TFU group and 3.0 mm Hg (20) fall in the usual care group (P = 0.29). Post hoc analysis showed that statin use increased from baseline to 6 months (P = 0.02) and cholesterol was significantly lower at 6 months in all patients (mean reduction 0.95 mmol/l; P < 0.001).


CONCLUSIONS
our study found TFU that promoted patient-led management of risk factors did not improve BP control over 6-month follow-up in primary care after stroke/TIA.
Adie
Katja
K
Care of the Elderly Department, Royal Cornwall Hospital, Truro, UK. katja.adie@rcht.cornwall.nhs.uk
James
Martin A
MA
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000517:prevention & control*; D055118:Medication Adherence; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D013689:Telephone