the prevents trial: the preventing recurrent events in veterans navigating transient ischemic attack (tia) or stroke trial

Conditions: Stroke; Transient Ischemic Attack

Summary: national recommendations state that patients with a history of transient ischemic attack (tia) or ischemic stroke should receive hypertension treatment, including antihypertensive medication and lifestyle modification, with a goal of reducing blood pressure (bp) to \<120 mm hg systolic bp and \<80 mm hg diastolic bp. statin treatment and lifestyle modification is also recommended for post-stroke and post-tia patients with elevated cholesterol levels or a history of stroke or tia with an atherosclerotic cause. despite the clear benefits of secondary stroke prevention, there is a gap between evidence and implementation in clinical practice. by a randomized controlled trial, the investigators will test whether a tailored, telephone-delivered transtheoretical model-based behavioral intervention will improve adherence to treatment in veterans with a history of tia or stroke, thereby leading to better control of bp and cholesterol levels, as compared to an attention placebo. the primary specific aims of this project are to: * determine whether a behaviorally tailored intervention (ti) can effectively lower bp after 6 months of counseling as compared to an attention placebo (ap) in veterans with a history of stroke or tia * assess whether the ti is effective in improving adherence to diet after 6 months of counseling in veterans with a history of stroke or tia. secondary aims are to * assess whether the ti is effective in improving cholesterol levels in post-stroke veterans after 6 months * evaluate whether the ti is effective in improving adherence to antihypertensive and lipid-lowering medications after 6 months of counseling in veterans with a history of stroke or tia * determine whether the ti is effective in improving adherence to exercise recommendations after 6 months. to answer this, veterans (n=190) with a history of stroke or tia will be randomized equally to the ti, which will use the transtheoretical framework to provide 6 monthly counseling phone sessions about adherence to diet, medication, and exercise recommendations, and the ap, in which 6 monthly counseling phone sessions about non-stroke-related health topics will be provided. participants will make in-person visits at baseline and 6 months. bp (3 measures taken at least 5 min apart) and dietary sodium are the primary outcomes, while secondary outcomes will be total cholesterol/high density lipoprotein ratio, adherence to antihypertensive and lipid-lowering drugs, and exercise adherence.


Eligibility criteria:
inclusion criteria: * well-documented history of stroke or tia * age 21 years or older * continuity of care in the primary care or neurology clinics, defined as at least 1 visit in either clinic during the past 1 year * on hypertensive and/or lipid-lowering agents * a score of \>16 on the mini-mental status exam- * ability to exercise (assessed by time to get up and go). exclusion criteria * limited life expectancy due to a severe non-cvd related comorbid terminal illness such as cancer * no telephone number at which patient can be reached * plans to relocate within the next 6 months * inability to communicate over the telephone due to severe cognitive impairment or aphasia

Keywords: hypertension stroke cholesterol adherence