STEPs to Blood Pressure Reduction.

STEPs to Blood Pressure Reduction. A Randomized Clinical Trial of the Stroke Transitions, Education, and Prevention Clinic Versus Usual Care for Post-Stroke Blood Pressure Reduction

The Stroke Transitions Education and Prevention (STEP) Clinic is a new type of clinic designed for stroke patients and was established to provide a comprehensive approach to stroke risk factor reduction. The goal of this study will be more effective than usual care at reducing blood pressure in patients with poorly controlled blood pressure after an ischemic or hemorrhagic stroke or transient ischemic attack.

STEP clinic patients will receive personalized goals, instructions to self-monitor, a blood pressure monitor, prescription medications, sleep apnea screening, dietary counseling, and more frequent follow-up if needed. A stroke neurologist will see patients in the usual care group and recommendations will be sent to their primary care providers.

Inclusion Criteria

• Age ≥ 18
• Clinical ischemic stroke, intracerebral hemorrhage, or transient ischemic attack
• Plan to discharge home or to short stay inpatient rehab after stroke
• Two of following required:
• History of hypertension (prior to hospitalization)
• Hospital blood pressure ≥ 140/90 on two or more occasions during hospitalization
• Discharge home on blood pressure medication
• Willingness and ability to follow-up in University of Texas Physicians stroke clinic

Exclusion Criteria:

• Modified Rankin scale (mRs) > 3 at enrollment
• Terminal illness
• Chronic kidney disease stage 4 or greater (eGFR < 30)
• Pregnancy
• Symptomatic flow limiting carotid stenosis without plan for intervention prior to clinic visit
• Stroke etiology presumed unrelated to atherosclerotic risk factors (amyloid angiopathy, vasculitis, malignancy associated)