Phone-Based Intervention Under Nurse Guidance for Control of Hypertension After Stroke: A Randomized Multicenter Phase 3 Trial in Ghana.
Stephen, S.F., Albert, A., S, B.A., Blay, N.S., Kwame, A.B.N., Rexford, A.G., Amankwaah, A.A., Christiana, D., Timothy, F., Gyebi, A.B.K., Emmanuel, A., Appiah, L.T., Abrafi, O.A.P., Sheila, A., Manolo, A., Nathaniel, A.M., Raelle, T., Michael, A., Osei, A.S., . . . Bruce, O. (2026). Phone-Based Intervention Under Nurse Guidance for Control of Hypertension After Stroke: A Randomized Multicenter Phase 3 Trial in Ghana.. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.125.077424
Stephen SF, Albert A, S BA, Blay NS, Kwame ABN, Rexford AG, et al. Phone-Based Intervention Under Nurse Guidance for Control of Hypertension After Stroke: A Randomized Multicenter Phase 3 Trial in Ghana.. Circulation. 2026; doi: 10.1161/CIRCULATIONAHA.125.077424
Stephen SF, Albert A, S BA, et al. Phone-Based Intervention Under Nurse Guidance for Control of Hypertension After Stroke: A Randomized Multicenter Phase 3 Trial in Ghana.[J]. Circulation. 2026. DOI: 10.1161/CIRCULATIONAHA.125.077424.
@article{stephen2026,
author = {Sarfo Fred Stephen and Akpalu Albert and Bockarie Ansumana S and Nguah Samuel Blay and Ayisi-Boateng Nana Kwame and Adu Gyamfi Rexford and Arthur Agnes Amankwaah and Duah Christiana and Fiattor Timothy and Agyenim-Boateng Kwadwo Gyebi and Achab Emmanuel and Lambert Tetteh Appiah and Opare-Addo Priscilla Abrafi and Adamu Sheila and Agbenorku Manolo and Adusei-Mensah Nathaniel and Tagge Raelle and Ampofo Michael and Asibey Shadrack Osei and Laryea Ruth and MacCready Evans and Sam Victoria Aba and Buadu Kwaku Affrim and Adu Solomon and Adu Darko Nyantakyi and Agbogbatey Melvin and Amuasi John H and Ovbiagele Bruce},
title = {Phone-Based Intervention Under Nurse Guidance for Control of Hypertension After Stroke: A Randomized Multicenter Phase 3 Trial in Ghana.},
journal = {Circulation},
year = {2026},
doi = {10.1161/CIRCULATIONAHA.125.077424},
note = {PMID: 41953982},
}
TY - JOUR AU - Sarfo Fred Stephen AU - Akpalu Albert AU - Bockarie Ansumana S AU - Nguah Samuel Blay AU - Ayisi-Boateng Nana Kwame AU - Adu Gyamfi Rexford AU - Arthur Agnes Amankwaah AU - Duah Christiana AU - Fiattor Timothy AU - Agyenim-Boateng Kwadwo Gyebi AU - Achab Emmanuel AU - Lambert Tetteh Appiah AU - Opare-Addo Priscilla Abrafi AU - Adamu Sheila AU - Agbenorku Manolo AU - Adusei-Mensah Nathaniel AU - Tagge Raelle AU - Ampofo Michael AU - Asibey Shadrack Osei AU - Laryea Ruth AU - MacCready Evans AU - Sam Victoria Aba AU - Buadu Kwaku Affrim AU - Adu Solomon AU - Adu Darko Nyantakyi AU - Agbogbatey Melvin AU - Amuasi John H AU - Ovbiagele Bruce TI - Phone-Based Intervention Under Nurse Guidance for Control of Hypertension After Stroke: A Randomized Multicenter Phase 3 Trial in Ghana. T2 - Circulation PY - 2026 DO - 10.1161/CIRCULATIONAHA.125.077424 AN - PMID:41953982 ER -
Addressing the rising burden of stroke in low-income countries will require pragmatic and scalable interventions targeting major risk factors. Under routine care settings, <10% of adults living with hypertension ever achieve blood pressure control, accentuating risks for adverse vascular events. The effectiveness of mobile health-centered, nurse-led interventions for the control of hypertension among patients with recent stroke in a resource-limited African setting is unknown. The PINGS (Phone-Based Intervention Under Nurse Guidance After Stroke) trial compared the efficacy and safety of usual care versus a 12-month intervention comprising home blood pressure self-monitoring with nurse case management for elevated home blood pressure recordings, use of phone alarms as medication reminders, and once-weekly education about cardiovascular risk reduction delivered by regular telephonic audio messages in selected Ghanaian dialects. This was a multicenter, randomized, open-label, blinded end point evaluation trial conducted at 10 hospitals between October 23, 2020, and April 5, 2024. We enrolled 500 patients ≥18 years with stroke within 1 month of onset and elevated blood pressure ≥140 or ≥90 mm Hg. The primary outcome was systolic blood pressure <140 mm Hg at month 12 by intention-to-treat principle. Secondary outcomes included major adverse cardiovascular events and serious adverse events. A total of 244 participants were assigned to the intervention group (PINGS) and 256 to the usual care group, of whom 43% were women, with mean (SD) age 58 (11) years. Mean change in systolic blood pressure at month 12 from baseline was -5.5 mm Hg (95% CI, -9.6 to -1.4 mm Hg; P=0.008). The primary outcome was achieved in 163 (67%) patients with PINGS versus 109 (43%) in the usual care arm, with a between-group difference of 24% (95% CI, 15%-33%; P<0.001). No significant between-group differences were noted in the secondary outcome of major adverse cardiovascular events or the presumed key mediator of medication adherence. Serious adverse events were 27 of 244 (11.1%) with PINGS versus 18 of 256 (7.0%) in usual care (P=0.12). Leveraging mhealth with minimal sophistication and task shifting to nurses on top of usual care could safely improve blood pressure control among stroke survivors in low-resource settings, but further study is warranted to confirm these findings and understand outcome drivers. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04404166.