Towards an integrated blood pressure self-monitoring solution for stroke/TIA in Ireland: a mixed methods feasibility study for the TASMIN5S IRL randomised controlled trial.
Towards an integrated blood pressure self-monitoring solution for stroke/TIA in Ireland: a mixed methods feasibility study for the TASMIN5S IRL randomised controlled trial.
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DOI：
10.1186/s40814-023-01240-2
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发表时间：
2023-01-13
影响因子：
1.7
通讯作者：
Glynn, L. G.
中科院分区：
文献类型：
--
作者：
Doogue, R.;Hayes, P.;Hebert, R.;Sheikhi, A.;Rai, T.;Morton, K.;Roman, C.;McManus, R. J.;Glynn, L. G.
关键词：
优化血压（BP）控制是预防后续卒中的最重要的可改变风险因素之一，收缩压每升高10 mmHg，风险增加三分之一。本研究评估了既往卒中或短暂性脑缺血发作（TIA）患者血压自我监测与计划药物滴定的可行性和潜在有效性，以告知干预的确定性试验。邀请有卒中/TIA病史且血压控制欠佳的患者参加一项随机对照试验的混合方法可行性研究。那些符合入选标准的收缩压>130 mmHg的患者被随机分配到自我监测干预组或常规护理组。干预措施包括每月在7天内每天两次自我监测BP，持续3天，然后发送短信提醒。根据这些读数的结果，根据全科医生（GP）和患者预先商定的计划启动治疗升级。半结构化的采访进行了与患者和临床医生，并按主题进行分析。在确定的人中，47%（32/68）参加了评估。在接受评估的患者中，15例符合招募条件，并同意以2：1的比例随机分配至干预组或对照组。在随机化的患者中，93%（14/15）完成了研究，没有不良事件。干预组在3个月时的收缩压较低。参与者认为干预措施可以接受，易于使用。全科医生发现很容易纳入他们的实践活动，而不增加工作量。TASMIN 5S是一种用于既往卒中/TIA患者的综合血压自我监测干预措施，在初级保健中提供是可行和安全的。预先商定的三步药物滴定计划很容易实施，增加了患者对护理的参与，并且没有不良反应。这项可行性研究提供了重要的信息，为确定卒中后或TIA患者干预的潜在有效性提供了明确的试验信息。ISRCTN57946500。于2019年12月8日注册。
Optimising blood pressure (BP) control is one of the most important modifiable risk factors in preventing subsequent stroke where the risk increases by one-third for every 10 mmHg rise in systolic BP. This study evaluated the feasibility and potential effectiveness of blood pressure self-monitoring with planned medication titration, to inform a definitive trial of the intervention, in patients with a previous stroke or transient ischaemic attack (TIA). Patients with a history of stroke/TIA and sub-optimal BP control were invited to take part in a mixed methods feasibility study for a randomised controlled trial. Those meeting the inclusion criteria with systolic BP >130 mmHg were randomised to a self-monitoring intervention group or usual care group. The intervention involved self-monitoring BP twice a day for 3 days within a 7-day period, every month, following text message reminders. Treatment escalation, based on a pre-agreed plan by the general practitioner (GP) and patient, was initiated according to the results of these readings. Semi-structured interviews were carried out with patients and clinicians and analysed thematically. Of those identified, 47% (32/68) attended for assessment. Of those assessed, 15 were eligible for recruitment and were consented and randomised to the intervention or control group on a 2:1 basis. Of those randomised, 93% (14/15) completed the study and there were no adverse events. Systolic BP was lower in the intervention group at 3 months. Participants found the intervention acceptable and easy to use. GPs found it easy to incorporate into their practice activity without increasing workload. TASMIN5S, an integrated blood pressure self-monitoring intervention in patients with a previous stroke/TIA, is feasible and safe to deliver in primary care. A pre-agreed three-step medication titration plan was easily implemented, increased patient involvement in their care, and had no adverse effects. This feasibility study provides important information to inform a definitive trial to determine the potential effectiveness of the intervention in patients post-stroke or TIA. ISRCTN57946500. Registered on 12/08/2019.
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1.7
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