Does self-monitoring and self-management of blood pressure after stroke or TIA improve control? TEST-BP, a randomized controlled trial

The therapeutic benefit of self-monitoring blood pressure in stroke patients is uncertain. We investigated the effect of self-monitoring with or without guided antihypertensive management compared with usual care in patients with a recent cerebrovascular event. No between-group differences in blood pressure at outcome were found, but blood pressure self-monitoring and management was well tolerated. Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention, even modest reductions in clinic blood pressure (BP) of approximately 10/5 mm Hg being associated with a 30% risk reduction.1 Despite the existence of effective treatments, rates of BP control after stroke are poor, a recent cohort reporting only 16% of patients achieving clinic BP ≤130/80 mm Hg 6 months after their event.2 Studies suggest that self-BP monitoring (SBPM) may improve BP control, its use resulting in lower BP levels and increased achievement of targets compared with usual management, particularly if combined with complementary strategies, such as telemonitoring of results, or guided antihypertensive self-management.3 However, studies to date have not addressed the use of SBPM in high-risk groups. Here we report the results of the TEST-BP trial, which aimed to determine whether SBPM with or without guided self-management of BP treatment resulted in lower BP levels and better control than usual care in hypertensive patients with a recent stroke or transient ischemic attack (TIA).