telehealth-enhanced assessment and management

Conditions: Blood Pressure

Summary: teams-bp is a patient-centered outcomes research institute (pcori)-funded trial under the phased large awards for comparative effectiveness research (placer) funding mechanism to evaluate two comprehensive and evidence-based strategies for managing blood pressure (bp) following stroke.

hypertension affects nearly half of the us population (46% of adults) and is the strongest risk factor for recurrent stroke. prevalence in patients with ischemic or hemorrhagic stroke in the us varies by region (highest in the south) ranging from 70% to 82%, and is associated with greater risk of recurrent stroke, major cardiovascular events, and death. a vital question for stroke patients and caregivers is how to prevent a recurrent stroke and further adverse events. multiple clinical trials have shown that lowering bp reduces the risk for cardiovascular disease and stroke. few trials, however, included stroke patients with a focus on secondary prevention nor were representative of vulnerable populations. the former us surgeon general recently published a call to action focused on bp with three goals: 1) make hypertension control a national priority; 2) ensure that communities support hypertension control; and 3) optimize patient care for hypertension control.

Eligibility criteria:
inclusion criteria: * diagnosis of ischemic stroke defined as acute brain, spinal cord, or retinal infarction based on objective evidence on imaging (such as a focal area of restricted diffusion on magnetic resonance imaging \[mri\]) in a defined vascular distribution or clinical evidence of focal ischemic injury based on symptoms persisting \> 24 hours; or spontaneous hemorrhagic stroke defined as a focal collection of blood within the brain parenchyma that is non-traumatic and identified by brain computed tomography (ct) or brain mri * age ≥18 years * discharged directly home from acute care or inpatient rehabilitation * at least one of the following: documented history of hypertension; self-reported history of hypertension; use of * hypertension medications (either prescribed prior to stroke, administered during hospital stay, or prescribed at discharge) * systolic blood pressure ≥ 130 mmhg * able to read and understand english or spanish, * have access to a functioning smartphone or tablet with cellular connectivity * willing to install and use a study-compatible physical activity monitoring application on their smartphone or tablet or smartphone or tablet of a qualifying caregiver * stated agreement to participate in either intervention to which they are assigned and attend all required study visits, * consent to receiving short message service (sms) required as part of the study interventions * consent to enrollment in chronic care management required as part of the study interventions, * provision of a signed and dated informed consent form exclusion criteria: * subdural hematoma or subarachnoid hemorrhage * current participation in another stroke clinical trial precluding dual enrollment * presence of terminal illness, such as cancer, that limits life expectancy to \<1 year * diagnosis of end-stage renal disease defined as permanent kidney dysfunction requiring the use of hemodialysis or peritoneal dialysis * pregnancy, lactation or planning to become pregnant * late-stage alzheimer's disease or related dementia * transitioned to a facility such as skilled nursing or long-term care prior to enrollment * mid upper arm circumference \> 45 cm/17.7 inches or \< 22 cm / 8.66 inches * missing values for systolic blood pressure or patient activation measure (pam) score at baseline * any condition that in the opinion of the study investigator would preclude the participant from being able to safely participate in the trial

Keywords: hypertension stroke cardiovascular events