Phone-Based Intervention Under Nurse Guidance for Control of Hypertension After Stroke: A Randomized Multicenter Phase 3 Trial in Ghana.

backgroundAddressing the rising burden of stroke in low-income countries will require pragmatic and scalable interventions targeting major risk factors. Under routine care settings, <10% of adults living with hypertension ever achieve blood pressure control, accentuating risks for adverse vascular events. The effectiveness of mobile health-centered, nurse-led interventions for the control of hypertension among patients with recent stroke in a resource-limited African setting is unknown.

methodsThe PINGS (Phone-Based Intervention Under Nurse Guidance After Stroke II) trial compared the efficacy and safety of usual care versus a 12-month intervention comprising home blood pressure self-monitoring with nurse case management for elevated home blood pressure recordings, use of phone alarms as medication reminders, and once-weekly education about cardiovascular risk reduction delivered by regular telephonic audio messages in selected Ghanaian dialects. This was a multicenter, randomized, open-label, blinded end point evaluation trial conducted at 10 hospitals between October 23, 2020, and April 5, 2024. We enrolled 500 patients ≥18 years with stroke within 1 month of onset and elevated blood pressure ≥140 or ≥90 mm Hg. The primary outcome was systolic blood pressure <140 mm Hg at month 12 by intention-to-treat principle. Secondary outcomes included major adverse cardiovascular events and serious adverse events.

resultsA total of 244 participants were assigned to the intervention group (PINGS) and 256 to the usual care group, of whom 43% were women, with mean (SD) age 58 (11) years. Mean change in systolic blood pressure at month 12 from baseline was -5.5 mm Hg (95% CI, -9.6 to -1.4 mm Hg;

conclusionsLeveraging mobile health intervention with minimal sophistication and task shifting to nurses on top of usual care safely improved blood pressure control among stroke survivors in a low-resource setting. Further study is warranted to confirm these findings and understand outcome drivers. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04404166.