Monitoring and controlling blood pressure after stroke and transient ischaemic attack

Thesis

Despite advances in treatment, the risk of recurrent vascular events after stroke and transient ischaemic attack (TIA) remains too high. Blood pressure is the strongest modifiable risk factor, but it is frequently undertreated. Stroke guidelines recommend a target blood pressure of <130/80 mmHg to prevent recurrence, but there remains much uncertainty about in whom, when, and how this should be achieved.

This thesis aims to investigate how best blood pressure should be measured, monitored, and controlled after TIA, ischaemic stroke, and intracerebral haemorrhage, using observational and randomised controlled trial evidence of a strategy of telemetric home blood pressure monitoring-guided antihypertensive treatment.

I have found that the method of blood pressure assessment typically used in current practice, i.e. the doctor or nurse measuring blood pressure in the clinic, is inaccurate for diagnosing high blood pressure. A few days of home blood pressure monitoring immediately after someone has a stroke or TIA, and ideally repeated around the time of the one-month follow-up assessment, is much more accurate. This identifies people whose blood pressure puts them at risk of recurrent vascular events and, therefore, who should receive blood pressure-lowering medication. I also showed that home blood pressure monitoring can be used to guide treatment, and achieves bigger reductions in blood pressure than usual care. However, stopping blood pressure-lowering medications in the long-term after TIA and stroke is a problem, and I have found that this has a bad prognosis in people who had their high blood pressure well controlled initially, so some form of ongoing blood pressure monitoring at home is probably required.

Authors: McGurgan, I

• DOI: 10.5287/ora-r86ga0mqv
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: home blood pressuere monitoring; secondary prevention; stroke; transient ischaemic attack; blood pressure; hypertension
• Subjects: Hypertension; Cerebrovascular disease