Abstract Number: Esoc2026lb171 Blood Pressure Telemonitoring and Rapid Treatment for Secondary Prevention of Ischaemic Stroke: A Phase 2b Randomised Controlled Trial

Abstract Background and aims Elevated blood pressure (BP) is associated with an increased risk of recurrence following ischaemic stroke or transient ischaemic attack (TIA). High rates of failure to achieve current guideline targets (BP 130/80mmHg) are reported. Home blood pressure measurement with telemonitoring (HBPM-TM) is a promising strategy but few randomised data exist after stroke. Methods In a Phase 2b randomised controlled pilot and feasibility trial, we randomly-allocated participants with recent ischaemic stroke or high-risk TIA (from 72 hours to 1 year post event) and baseline SBP≥130mmHg. The intervention was HBPM-TM using a dedicated smartphone App, with a rapid (at least weekly) treatment strategy (HBPM-TM/RT), or usual care (office/hospital measures, and/or HBPM to target SBP130mmHg). The primary outcome was mean clinic SBP at 3 months post-randomisation. Results Of 27 randomised participants, primary outcome data was available for 24 (intervention n=13, usual care n=11, 3 lost to follow-up/withdrew consent). Mean baseline SBP was 150mmHg in both groups. At 3 months, the mean SBP in the HBPM-TM/RT group was 129mmHg (SD 14.7), versus 139mmHg (SD 6.2) in the usual care group (p=0.04). Achievement of SBP guideline targets at 3 months was 62% (8/13) in HBPM-TM/RT patients versus 9% (1/11) in usual care (p=0.01). Serious adverse events were balanced between both groups. Conclusions An App-based HBPM-TM strategy combined with rapid physician-directed medication titration improved control of blood pressure following ischaemic stroke or TIA. Phase 3 randomised trials are required to confirm these findings and to evaluate the impact on recurrent events. Conflict of interest