Priority Programme Award (Clinical Trial)
Professor David Werring, University College London
Description of research
In the UK around 150,000 people have a stroke every year, with up to 23,000 caused by bleeding in the brain, called intracerebral haemorrhage (ICH).
ICH is fatal in nearly 50% of cases, and survivors often have physical or memory and thinking (cognitive) problems, with a risk of further ICH and worsening cognition. Effective prevention of recurring ICH is therefore a key research goal.
ICH is usually due to a disease in the small blood vessels damaged by high blood pressure. Lowering blood pressure (BP) is the most promising way to prevent ICH, but many stroke survivors do not achieve good BP control. It is not known how lowering BP protects the brain, how much to lower it by, for how long, or how best to properly control it longer term. ‘Telemetric’ BP home monitoring looks very promising to control BP in minor stroke or transient ischaemic attack (TIA, “ministroke”), but has not been tested in survivors of ICH, who have more disability, or at multiple hospital centres.
In this study 100 ICH survivors will be randomly allocated to either home BP monitoring using telemetry (sending BP information to a study co-ordinating centre) to allow treatment adjustments to improve BP control; or to standard care. MRI scans of the brain will be taken to see whether intensive BP treatment reduces brain injury over time, assessed by the build-up of new, tiny areas of bleeding (cerebral microbleeds).
This study could show whether more intensive lowering of BP in survivors of ICH is possible, safe and effective in reducing brain injury. If successful, a larger definitive trial may be designed. The intervention should allow survivors of ICH to know, understand and manage their own BP to prevent strokes and cognitive impairment and improve outcomes.