Mixed methods feasibility study for a trial of blood pressure telemonitoring for people who have had stroke/transient ischaemic attack (TIA)

BackgroundGood blood pressure (BP) control reduces the risk of recurrence of stroke/transient ischaemicattack (TIA). Although there is strong evidence that BP telemonitoring helps achieve goodcontrol, none of the major trials have considered the effectiveness in stroke/TIA survivors.We therefore conducted a feasibility study for a trial of BP telemonitoring for stroke/ TIAsurvivors with uncontrolled BP in primary care.MethodPhase 1 was a pilot trial involving 55 patients stratified by stroke/TIA randomised 3:1 to BPtelemonitoring for 6 months or usual care. Phase 2 was a qualitative evaluation andcomprised semi-structured interviews with 16 trial participants who received telemonitoringand 3 focus groups with 23 members of stroke support groups and 7 carers.ResultsOverall, 125 patients (60 stroke patients, 65 TIA patients) were approached and 55 (44%)patients were randomised including 27 stroke patients and 28 TIA patients. Fifty-twoparticipants (95%) attended the 6-month follow-up appointment, but one declined the seconddaytime ambulatory blood pressure monitoring (ABPM) measurement resulting in a 93%completion rate for ABPM ? the proposed primary outcome measure for a full trial.Adherence to telemonitoring was good; of the 40 participants who were telemonitoring, 38continued to provide readings throughout the 6 months. There was a mean reduction of 10.1mmHg in systolic ABPM in the telemonitoring group compared with 3.8 mmHg in thecontrol group, which suggested the potential for a substantial effect from telemonitoring. Ourqualitative analysis found that many stroke patients were concerned about their BP andtelemonitoring increased their engagement, was easy, convenient and reassuringConclusionsA full-scale trial is feasible, likely to recruit well and have good rates of compliance andfollow-up