Description of research
People who have survived a previous stroke or transient ischaemic attack (TIA) are at particularly high risk of subsequent, ‘recurrent’ stroke with 30% having another stroke in the following five years.
High blood pressure is the most important reversible risk factor for having a recurrent stroke. Previous studies suggest that measuring blood pressure at home (self-monitoring) may help to control blood pressure.
The aim of this study is to develop and test a self-monitoring system tailored to the needs of stroke and TIA survivors, which will include self-adjustment of medication where possible in consultation with a GP. In addition, GPs will receive reminders to think about problems patients may have with taking medication and potential specialist referral if a patient’s blood pressure remains high.
The study will have three parts. In the first, the self-monitoring system will be tested by trying it out with both patients and GPs who will be asked to talk through what they think of it. A randomised controlled trial (RCT) will then be conducted to see if the self-monitoring system works, by comparing patients who are randomly assigned to either self-monitor or receive usual GP care. Finally, an assessment of value for money will be conducted, including both what happened during the trial and what might happen should self-monitoring be implemented in clinical practice in the long term.
The first part of the study will develop the self-monitoring intervention using mobile phones (using a text message or app) to send blood pressure readings and provide automatic feedback to patients. The main aim of the study is showing whether or not the systolic blood pressure of patients is reduced after a year. The costing work in the second part of the study should show whether the self-monitoring would be considered good value for money.
Overall, it is hoped that this work will be able to develop and test a new self-monitoring system for the control of blood pressure after stroke or TIA, and which could reduce subsequent stroke (and heart attacks) and prove good value for money. It also hoped that the system produced could be introduced quickly within the NHS and inform national guidelines.