Remote Blood Pressure Monitoring of Stroke Survivors in Underresourced Areas Show Promise

February 3, 2022—The American Stroke Association (ASA) announced the presentation of preliminary research showing that a new strategy using telehealth to monitor blood pressure at home for several months immediately after a stroke had a positive impact on patient engagement and blood pressure control among people who live in historically underresourced communities. The findings were presented at ASA’s International Stroke Conference 2022 held on February 8-11 both virtually and in New Orleans, Louisiana.

In this feasibility study, investigators from Columbia University in New York, New York, tested the potential impact of a new multidisciplinary strategy called Telehealth After Stroke Care for stroke survivors who received poststroke care at NewYork–Presbyterian/Columbia University Irving Medical Center. The study took place in New York City’s Northern Manhattan area with an underserved community.

As summarized in the AHA press release, study participants included 50 stroke survivors (44% were Hispanic adults, 32% were Black adults, and 20% were White adults), with an average age of 64 years. Approximately half (54%) of the participants had up to a high school education, and 30% had private health insurance.

Patients were randomly divided into two groups: Half of the study participants received usual care (the control group), and the other half were supported with enhanced telehealth after their stroke (the intervention group). Both groups were enrolled before hospital discharge and followed for 90 days—the window of time when the risk of having another stroke is the highest.

Patients assigned to the control group had a video conference appointment with a primary care professional 1 to 2 weeks after hospital discharge and video conference appointments with a stroke specialist at 6 and 12 weeks after discharge.

Participants in the enhanced telehealth group received mobile tablet devices, blood pressure monitors, and video visits with a multidisciplinary team, including pharmacy support.

The home blood pressure monitor remotely sent the participant’s readings to the patient’s electronic health record. Based on these remote readings, a nurse provided call support and could escalate to telepharmacists and physicians, if needed.

The enhanced telehealth group also received a plain-language blood pressure infographic in English or Spanish that was specifically tailored to their individual health information to help educate them about healthy blood pressure levels, goals, and ways to improve their blood pressure. Home blood pressure was measured at the end of the study.

The ASA press release outlined the study’s key findings as follows:

• The Telehealth After Stroke Care strategy had a significant improvement in patient follow-up: 84% of patients in the enhanced telehealth group completed the 12-week study compared to 64% of patients in the usual care group.
• 91% of patients in the enhanced telehealth group completed the video visit with primary care professionals and specialists compared to 75% of patients in the usual care group.
• Blood pressure control was better in the enhanced telehealth group at 76% compared to 25% control in the control group.
• Among Black study participants, blood pressure control improved from 40% of participants at enrollment to 100% at the study’s conclusion in the enhanced telehealth group and improved only from 14% to 29% in the control group.

The investigators urge caution regarding interpreting results from this feasibility study, which are promising but warrant further replication in a larger trial, noted the ASA press release.

Imama A. Naqvi, MD, is lead author of the study, an Assistant Professor of Neurology at Columbia University Vagelos College of Physicians and Surgeons, and a neurologist with New York–Presbyterian/Columbia University Irving Medical Center.

Commenting in the ASA press release, Dr. Naqvi stated, “Hypertension is the most important modifiable risk factor for a second or recurrent stroke. We know that a small change to lower systolic blood pressure reduces recurrent stroke risk by > 20%. Yet, blood pressure is poorly controlled among more than half of stroke survivors. We also know that Black adults have a higher prevalence of uncontrolled blood pressure. In addition, Black and Hispanic populations have a higher risk of stroke, and the highest increase in stroke prevalence is expected to be among Hispanic males.”

Dr. Naqvi continued, “COVID-19 has highlighted numerous health inequities that make poststroke care more difficult and created a gap in health outcomes for people from diverse racial and ethnic groups. We need to devise ways to bridge this divide. Mobile health tools such as wireless blood pressure devices that enable remote monitoring are here to stay, and we need to find ways to utilize telemedicine to improve care for all stroke survivors. As physicians, we want to provide patients with equitable access to care and find the right poststroke care interventions that engage patients and improve health outcomes.”

Willie Lawrence, MD, Chairman of the American Heart Association’s National Hypertension Control Initiative’s oversight committee, added in the ASA press release, “This new research will continue to strengthen our work and commitment to addressing health inequities by focusing on blood pressure through regular remote monitoring and partnering with our patients. The goal of the National Hypertension Control Initiative is to improve blood pressure control rates in historically underresourced communities. By applying a multifaceted approach that includes comprehensive training and technical assistance for professionals in community health centers, collaboration with trusted community-based organizations, and direct patient education, we hope to empower communities with blood pressure education and resources that can improve outcomes before a stroke occurs but also create a network of care and support after a stroke.”