title: Randomized controlled trial of a multipronged intervention to improve blood pressure control among stroke survivors in Nigeria.
abstract: BACKGROUND
  Stroke is the second-leading cause of death in low- and middle-income countries, but use of evidence-based therapies for stroke prevention in such countries, especially those in Africa, is extremely poor. This study is designed to enhance the implementation and sustainability of secondary stroke-preventive services following hospital discharge.
  
  
  OBJECTIVE
  The primary study aim is to test whether a Chronic Care Model-based initiative entitled the Tailored Hospital-based Risk reduction to Impede Vascular Events after Stroke (THRIVES) significantly improves blood pressure control after stroke.
  
  
  METHODS
  This prospective triple-blind randomized controlled trial will include a cohort of 400 patients with a recent stroke discharged from four medical care facilities in Nigeria. The culturally sensitive, system-appropriate intervention comprises patient report cards, phone text messaging, an educational video, and coordination of posthospitalization care.
  
  
  RESULTS
  The primary outcome is improvement of blood pressure control. Secondary endpoints include control of other stroke risk factors, medication adherence, functional status, and quality of life. We will also perform a cost analysis of THRIVES from the viewpoint of government policy-makers.
  
  
  CONCLUSIONS
  We anticipate that a successful intervention will serve as a scalable model of effective postdischarge chronic blood pressure management for stroke in sub-Saharan Africa and possibly for other symptomatic cardiovascular disease entities in the region.
authors.affiliation: Department of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Mayowa O
authors.initials: MO
authors.lastname: Owolabi
authors.forename: Rufus O
authors.initials: RO
authors.lastname: Akinyemi
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.forename: Olanrewaju
authors.initials: O
authors.lastname: Olaniyan
authors.forename: Babatunde L
authors.initials: BL
authors.lastname: Salako
authors.forename: Oyedunni
authors.initials: O
authors.lastname: Arulogun
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D009549:Nigeria / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012307:Risk Factors; D018401:Sample Size; D020521:Stroke / Q000401:mortality / Q000503:physiopathology* / Q000523:psychology*; D017741:Survivors / Q000523:psychology
chemical_list: D000927:Anticonvulsants
keywords: Chronic Care Model; hypertension; low- and middle- income countries; patient report card; secondary prevention; stroke