Reducing Risk of Recurrence
| Status: | Completed |
|---|---|
| Conditions: | High Blood Pressure (Hypertension), High Cholesterol, Neurology |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Neurology |
| Healthy: | No |
| Age Range: | 21 - Any |
| Updated: | 4/21/2016 |
| Start Date: | January 2010 |
| End Date: | June 2015 |
Reducing Risk of Recurrences: Issues in Maintenance and Stability in Stroke (CDA 08-009)
Adults who have had a previous stroke or transient ischemic attack (TIA) remain at risk for
having a second serious event, especially if they have uncontrolled blood pressure or
cholesterol. However, many patients have difficulty following treatment recommendations for
lowering blood pressure and cholesterol. The purpose of this research project is to evaluate
the effect of 2 booster sessions of an educational counseling intervention on how well
adults who have already participated in a 6-month clinical trial had a stroke or transient
ischemic attack (TIA) are able to follow a treatment plan and control their blood pressure
and cholesterol levels. We will also examine how effective this intervention is in improving
adherence to diet, medication, and physical activity recommendations for adults who have had
a prior stroke or TIA.
having a second serious event, especially if they have uncontrolled blood pressure or
cholesterol. However, many patients have difficulty following treatment recommendations for
lowering blood pressure and cholesterol. The purpose of this research project is to evaluate
the effect of 2 booster sessions of an educational counseling intervention on how well
adults who have already participated in a 6-month clinical trial had a stroke or transient
ischemic attack (TIA) are able to follow a treatment plan and control their blood pressure
and cholesterol levels. We will also examine how effective this intervention is in improving
adherence to diet, medication, and physical activity recommendations for adults who have had
a prior stroke or TIA.
National recommendations state that patients with a history of transient ischemic attack
(TIA) or ischemic stroke should receive hypertension treatment, including antihypertensive
medication and lifestyle modification, with a goal of reducing blood pressure (BP) to <120
mm Hg systolic BP and <80 mm Hg diastolic BP. Statin treatment and lifestyle modification is
also recommended for post-stroke and post-TIA patients with elevated cholesterol levels or a
history of stroke or TIA with an atherosclerotic cause. Despite the clear benefits of
secondary stroke prevention, there is a gap between evidence and implementation in clinical
practice. We will determine whether a telephone-delivered behaviorally tailored intervention
(TI) can lead to sustained change resulting in (a) BP and lipid control and (b) improved
adherence to diet, medication, and exercise recommendations in veterans with a history of
stroke or TIA compared to an attention placebo (AP) in veterans who have completed 6 months
of a clinical trial. In this CDA project, we evaluate the long-term effectiveness of booster
sessions in a randomized manner. One arm will receive 6 months of a tailored intervention
(TI) followed by two booster TI sessions at 8 and 10 months, and one arm will receive 6
months of an attention placebo (AP) followed by two booster AP sessions at 8 and 10 months.
BP (3 measures taken at least 5 min apart) and dietary sodium are the primary outcomes,
while secondary outcomes will be total cholesterol/high density lipoprotein ratio, adherence
to antihypertensive and lipid-lowering drugs, and exercise adherence.
(TIA) or ischemic stroke should receive hypertension treatment, including antihypertensive
medication and lifestyle modification, with a goal of reducing blood pressure (BP) to <120
mm Hg systolic BP and <80 mm Hg diastolic BP. Statin treatment and lifestyle modification is
also recommended for post-stroke and post-TIA patients with elevated cholesterol levels or a
history of stroke or TIA with an atherosclerotic cause. Despite the clear benefits of
secondary stroke prevention, there is a gap between evidence and implementation in clinical
practice. We will determine whether a telephone-delivered behaviorally tailored intervention
(TI) can lead to sustained change resulting in (a) BP and lipid control and (b) improved
adherence to diet, medication, and exercise recommendations in veterans with a history of
stroke or TIA compared to an attention placebo (AP) in veterans who have completed 6 months
of a clinical trial. In this CDA project, we evaluate the long-term effectiveness of booster
sessions in a randomized manner. One arm will receive 6 months of a tailored intervention
(TI) followed by two booster TI sessions at 8 and 10 months, and one arm will receive 6
months of an attention placebo (AP) followed by two booster AP sessions at 8 and 10 months.
BP (3 measures taken at least 5 min apart) and dietary sodium are the primary outcomes,
while secondary outcomes will be total cholesterol/high density lipoprotein ratio, adherence
to antihypertensive and lipid-lowering drugs, and exercise adherence.
Inclusion Criteria:
- Well-documented history of stroke or TIA that occurred at least 3 months prior to
enrollment;
- Age 21 years or older;
- Continuity of care in the VAMC primary care or neurology clinics, defined as at least
1 visit in either clinic during the past 1 year;
- On hypertensive and/or lipid-lowering agents;
- A score of >16 on the Mini-Mental Status Exam;
- ability to exercise (assessed by 6-minute walk or timed get up and go).
Exclusion Criteria:
- Limited life expectancy due to a severe non-CVD related comorbid terminal illness
such as cancer;
- No telephone number at which patient can be reached;
- Plans to relocate outside of the NYC area within the next 6 months;
- Inability to communicate over the telephone due to severe cognitive impairment or
aphasia.
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