Home BP Plus Nurse Monitoring Slashes BP Post-Stroke

LOS ANGELES — Combining home blood pressure telemonitoring and nurse case management had a big impact on blood pressure in secondary stroke prevention among minorities, a randomized trial showed.

While home blood pressure telemonitoring alone improved systolic blood pressure by a respectable 5.53 mm Hg from baseline to 12 months, the combination approach yielded a whopping 14.76 mm Hg reduction for a more than 9 mm Hg advantage (P<0.0001).

Diastolic blood pressure also improved significantly more with the combination approach, albeit by a more modest 3.49 mm Hg differential, reported Gbenga Ogedegbe, MD, MPH, of NYU Langone Health in New York City, at the International Stroke Conference.

The other primary endpoint, rate of recurrent stroke at 24 months, was not yet reported.

The trial included 450 black and Hispanic adults with an ischemic or hemorrhagic stroke within the prior year who had systolic blood pressure of 140 mm Hg or greater at two office visits over a 2-week period. Participants spoke English or Spanish and were seen at comprehensive stroke centers or primary care practices of six public hospitals and three academic centers in New York City.

Home blood pressure telemonitoring intervention involved home readings 3 days a week wirelessly transmitted to a central secure server, with summary reports sent to patients and physicians before each clinic appointment for 12 months. The nurse care management intervention comprised 20 calls with a nurse to evaluate and advise on home blood pressure data and counsel about lifestyle behaviors and medication adherence.

While the intervention was labor intensive, it was less so than many of the navigator trials and could be especially appealing if combined with an automatic reporting platform like that used in the COMPASS-CP study, commented Jeffrey Saver, MD, of the University of California Los Angeles.

“As we move to a more ubiquitously telemonitored health environment, then we can really leverage prevention,” he told MedPage Today. “This gives us a glimpse of that future.”

Mariell Jessup, MD, chief medical officer of the American Heart Association, praised the study for targeting a minority population with historically poorer outcomes and a higher likelihood of having hypertension as the mechanism of stroke. “Equity in stroke care is really important.”