Does telephone follow-up improve blood pressure after minor stroke or TIA?

Background: hypertension is a common risk factor for stroke/transient ischaemic attack (TIA) and there is good evidence that blood pressure (BP) control prevents recurrent stroke. We investigated whether telephone follow-up (TFU) improved risk factor management in hypertensive patients after stroke/TIA. Methods: we conducted a randomised controlled trial and assigned hypertensive patients within 1 month of stroke or TIA to receive usual care (n = 27) or usual care plus regular TFU (n = 29). Primary outcome was the difference in 12 h ambulatory systolic BP change from baseline to 6 months (Delta SBP) in both groups. TFU at 7 days, 1, 2 and 4 months included patient-focussed education and goal setting. Results: mean baseline BP was 145/83 mm Hg (standard deviation (SD) 21/14). There was no significant difference in Delta SBP over 6 months with TFU. Median Delta SBP was 0 mm Hg (interquartile range 19.5) in the TFU group and 3.0 mm Hg (20) fall in the usual care group (P = 0.29). Post hoc analysis showed that statin use increased from baseline to 6 months (P = 0.02) and cholesterol was significantly lower at 6 months in all patients (mean reduction 0.95 mmol/l; P < 0.001). Conclusion: our study found TFU that promoted patient-led management of risk factors did not improve BP control over 6-month follow-up in primary care after stroke/TIA.