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The study evaluates the effect of early follow up in a preventive clinic with stepwise treatment of high blood pressure and lowering blood cholesterol. Half the participants were randomized to the preventive clinic group and the other half to control group with the usual treatment: one visit to the outpatient clinic three months after discharge with a diagnosis of stroke or transient ischemic attack (TIA)
Hypertension is the most important modifiable risk factor for recurrent stroke. Several studies have shown that less than 40% of stroke survivors are treated to target one year after stroke The investigator performed a feasibility study to test a model of treating this important risk factor in a hospital setting The investigator used a stepwise escalation of treatment of both blood pressure and blood cholesterol to individual targets according to patients' diagnosis of stroke, comorbidity and age
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Experimental | Initiation/stepwise escalation of antihypertensive medication in case of blood pressure above individual target Initiation/stepwise escalation of cholesterol lowering medication in case of LDL-cholesterol above individual target Advice on healthy lifestyle and life long adherence to preventive medication |
|
| Control group | No Intervention | Participants had the usual treatment: all patients were invited to one visit in the outpatient clinic three months after discharge with a diagnosis of stroke/TIA |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Intervention | Behavioral | Prevention of recurrent stroke, myocardial infarction and death Stepwise escalation of preventive medication Life style counselling including adherence to preventive treatment |
| Measure | Description | Time Frame |
|---|---|---|
| Blood pressure treated to target | The investigator used individual targets of blood pressure: In case of hemorrhagic stroke: BP<130/80 mm Hg, in case of ischemic heart disease: BP target according to stroke diagnosis, but no lower than 130/80 mm Hg, in case of diabetes or chronic kidney disease: BP<130/80 mm Hg, age>80 years: <150/90 mm Hg, others: <140/90 mm Hg | At follow up 10 months after inclusion in the study |
| Measure | Description | Time Frame |
|---|---|---|
| Reduction in blood pressure | Difference between blood pressure at inclusion in the study and blood pressure measured at final follow up | At follow up 10 months after inclusion in the study |
| Measure | Description | Time Frame |
|---|---|---|
| Reduction in LDL-cholesterol | Difference between LDL-cholesterol at inclusion in the study and LDL-cholesterol measured at final follow up | At follow up 10 months after inclusion in the study |
| LDL-cholesterol treated to target |
Inclusion Criteria: Patients diagnosed with a stroke during stay in the stroke unit of Herlev Hospital
Exclusion Criteria: Severe stroke giving a modified Rankin Scale score >4, severe cognitive deficits or dementia, discharge to a nursing home
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| Name | Affiliation | Role |
|---|---|---|
| Nete Hornnes, MPH,Ph.d | Department of Neurology, Herlev Hospital, 2730 Herlev, Denmark | Principal Investigator |
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| ID | Term |
|---|---|
| D020521 | Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D008722 | Methods |
| ID | Term |
|---|---|
| D008919 | Investigative Techniques |
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Participants were randomized 1:1 to intervention or control group
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In non-diabetic participants with ischemic stroke the target of lipid lowering treatment was LDL<2.5 mmol/l and <2.0 mmol/l in case of diabetes
| At follow up 10 months after inclusion in the study |
| Intensification of preventive treatment | Proportion of participants who had an intensification of antihypertensive / lipid lowering medication since discharge | From discharge from the stroke unit to final follow up in study |
| Adherence with preventive medication | Proportion of participants with at least 80% adherence with preventive medication | At follow up 10 months after inclusion in the study |
| Healthy lifestyle | Proportion of participants on a healthy diet, moderate physical activity for four hours/week, smoking cessation in baseline daily smokers, reduction of an overuse of alcohol to recommended level | At follow up 10 months after inclusion in the study |
| Time to cardiovascular complications | Time to recurrent stroke, myocardial infarction and death in months | From inclusion in the study to a median of 65 (61-66) months after inclusion |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |