BACKGROUND/RATIONALE:
Patients who survive a first stroke or transient ischemic attack (TIA) remain at risk for future cerebrovascular events. Patients with recurrent stroke face a mortality rate of 1.8 times that of those with a first stroke, as well as a high risk of disability. Uncontrolled blood pressure (BP) and cholesterol significantly increase the risk of stroke recurrence, and there is strong evidence that secondary prevention strategies such as BP and cholesterol-lowering treatments can significantly reduce the prevalence of recurrent stroke. Despite the benefits of secondary stroke prevention, many patients do not reach BP and cholesterol targets, in part due to lack of adherence to treatment recommendations. Even in patients who successfully change their behavior to adhere to diet, medication, and exercise recommendations, long-term maintenance of health behavior changes can be difficult to sustain.

OBJECTIVE(S):
We will determine whether a telephone-delivered behaviorally tailored intervention (TI) with booster sessions 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.

METHODS:
One arm will receive 6 months of a telephone-delivered tailored intervention (TI) followed by two booster TI sessions at 8 and 10 months, based on the Transtheoretical Model and focusing on diet, medication, and exercise. The second arm will receive 6 months of an attention placebo (AP), which entails standard education about prevention of health conditions that are not related to cardiovascular disease or stroke (a different health topic will be discussed in each call), 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.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
This study provides insight into the sustainability of behavioral interventions to improve recurrent stroke risk.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Friedberg JP, Lipsitz SR, Natarajan S. Challenges and recommendations for blinding in behavioral interventions illustrated using a case study of a behavioral intervention to lower blood pressure. Patient education and counseling. 2010 Jan 1; 78(1):5-11. [view]
2. Ulmer M, Robinaugh D, Friedberg JP, Lipsitz SR, Natarajan S. Usefulness of a run-in period to reduce drop-outs in a randomized controlled trial of a behavioral intervention. Contemporary clinical trials. 2008 Sep 1; 29(5):705-10. [view]

Conference Presentations

1. Friedberg JP, Ulmer ME, Lin I, Grand E, Lipsitz SR, Natarajan S. Alcohol consumption and adherence to the DASH diet in veterans with hypertension. Poster session presented at: American Public Health Association Annual Meeting and Exposition; 2010 Nov 7; Denver, CO. [view]
2. Natarajan S, Friedberg JP, Ulmer ME, Lin I, Robinaugh D, Allegrante JP, Wylie-Rosett J, Lipsitz SR. Comparative effectiveness of two telephone-delivered behavioral interventions to improve hypertension control. Primary outcomes of a randomized controlled trial. Paper presented at: American Heart Association Scientific Sessions Late-Breaking Clinical Trial Report; 2010 Nov 16; Chicago, IL. [view]

DRA: Aging, Older Veterans' Health and Care, Brain and Spinal Cord Injuries and Disorders, Cardiovascular Disease
DRE: Diagnosis, Prevention, Prognosis, Treatment - Comparative Effectiveness
Keywords: none
MeSH Terms: none