title: Home blood pressure monitoring with nurse-led telephone support among patients with hypertension and a history of stroke: a community-based randomized controlled trial.
abstract: BACKGROUND
  Adequate control of blood pressure reduces the risk of recurrent stroke. We conducted a randomized controlled study to determine whether home blood pressure monitoring with nurse-led telephone support would reduce blood pressure in patients with hypertension and a history of stroke.
  
  
  METHODS
  We recruited 381 participants (mean age 72 years) from outpatient and inpatient stroke clinics between Mar. 1, 2007, and Aug. 31, 2009. Nearly half (45%, 170) of the participants had some disability due to stroke. Participants were visited at home for a baseline assessment and randomly allocated to home blood pressure monitoring (n = 187) or usual care (n = 194). Those in the intervention group were given a monitor, brief training and telephone support. Participants who had home blood pressure readings consistently over target (target < 130/80 mm Hg) were advised to consult their family physician. The main outcome measure was a fall in systolic blood pressure after 12 months, measured by an independent researcher unaware of group allocation.
  
  
  RESULTS
  Despite more patients in the intervention group than in the control group having changes to antihypertensive treatment during the trial period (60.1% [98/163] v. 47.6% [78/164], p = 0.02), the fall in systolic blood pressure from baseline did not differ significantly between the groups (adjusted mean difference 0.3 mm Hg, 95% confidence interval -3.6 to 4.2 mm Hg). Subgroup analysis showed significant interaction with disability due to stroke (p = 0.03 at 6 months) and baseline blood pressure (p = 0.03 at 12 months).
  
  
  CONCLUSIONS
  Overall, home monitoring did not improve blood pressure control in patients with hypertension and a history of stroke. It was associated with a fall in systolic pressure in patients who had uncontrolled blood pressure at baseline and those without disability due to stroke.
  
  
  BACKGROUND
  ClinicalTrials.gov registration NCT00514800.
authors.affiliation: Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK. s.m.kerry@qmul.ac.uk
authors.forename: Sally M
authors.initials: SM
authors.lastname: Kerry
authors.forename: Hugh S
authors.initials: HS
authors.lastname: Markus
authors.forename: Teck K
authors.initials: TK
authors.lastname: Khong
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Cloud
authors.forename: Jenny
authors.initials: J
authors.lastname: Tulloch
authors.forename: Denise
authors.initials: D
authors.lastname: Coster
authors.forename: Judith
authors.initials: J
authors.lastname: Ibison
authors.forename: Pippa
authors.initials: P
authors.lastname: Oakeshott
mesh_terms: D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods* / Q000451:nursing; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D008297:Male; D020521:Stroke / Q000517:prevention & control*; D013689:Telephone