Lady Estelle Wolfson, Professor David Werring & Professor Sir Mark Walport

Awardee: Professor David Werring, University College London

Award Type: Priority Programme Award (Clinical Trial)

Research Title:

Protecting the brain after a haemorrhage by improving blood pressure control using home monitoring (PROHIBIT-ICH)

Description of research:

What is the research about? In the UK, about 150,000 people have a stroke per year; up to about 23,000 are due to bleeding in the brain – intracerebral haemorrhage (ICH). ICH is fatal in nearly 50% of cases, and survivors often have physical or cognitive (memory) problems and a risk of further ICH and worsening cognition. Effective prevention of recurrent ICH is a key research goal. ICH is usually due to disease of 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. We do not know how BP lowering protects the brain, how much to lower it, 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.

What does the research involve? We will randomly allocate ICH survivors 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. We will include MRI scans to see whether intensive BP treatment reduces brain injury over time, assessed by the build-up of new tiny areas of bleeding (cerebral microbleeds).

What are the expected benefits from the research? Our study will show whether more intensive lowering of BP in survivors of ICH is feasible, safe and effective in reducing brain injury. If successful we will be able to design a larger definitive trial. Our intervention should allow survivors of ICH to know, understand, and manage their own BP to prevent strokes and cognitive impairment, and improve outcomes.