Randomized controlled trial of a multipronged intervention to improve blood pressure control among stroke survivors in Nigeria

Int J Stroke. 2014 Dec;9(8):1109-16. doi: 10.1111/ijs.12331. Epub 2014 Jul 18.


Rationale: Stroke is the second-leading cause of death in low- and middle-income countries, but use of evidence-based therapies for stroke prevention in such countries, especially those in Africa, is extremely poor. This study is designed to enhance the implementation and sustainability of secondary stroke-preventive services following hospital discharge.

Aim/hypothesis: The primary study aim is to test whether a Chronic Care Model-based initiative entitled the Tailored Hospital-based Risk reduction to Impede Vascular Events after Stroke (THRIVES) significantly improves blood pressure control after stroke.

Design: This prospective triple-blind randomized controlled trial will include a cohort of 400 patients with a recent stroke discharged from four medical care facilities in Nigeria. The culturally sensitive, system-appropriate intervention comprises patient report cards, phone text messaging, an educational video, and coordination of posthospitalization care.

Study outcomes: The primary outcome is improvement of blood pressure control. Secondary endpoints include control of other stroke risk factors, medication adherence, functional status, and quality of life. We will also perform a cost analysis of THRIVES from the viewpoint of government policy-makers.

Discussion: We anticipate that a successful intervention will serve as a scalable model of effective postdischarge chronic blood pressure management for stroke in sub-Saharan Africa and possibly for other symptomatic cardiovascular disease entities in the region.

Trial registration: ClinicalTrials.gov NCT01900756.

Keywords: Chronic Care Model; hypertension; low- and middle- income countries; patient report card; secondary prevention; stroke.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Anticonvulsants / therapeutic use*
  • Blood Pressure / drug effects*
  • Blood Pressure / physiology*
  • Cohort Studies
  • Costs and Cost Analysis
  • Electronic Health Records
  • Female
  • Humans
  • Male
  • Medication Adherence
  • Nigeria / epidemiology
  • Outcome Assessment, Health Care
  • Quality of Life
  • Risk Factors
  • Sample Size
  • Stroke / mortality
  • Stroke / physiopathology*
  • Stroke / psychology*
  • Survivors / psychology


  • Anticonvulsants

Associated data

  • ClinicalTrials.gov/NCT01900756