Phone-based strategy supports BP control after a stroke

A nurse-led mobile health (mHealth) intervention that utilizes basic phones improves blood pressure (BP) control among stroke survivors in Ghana, as shown in the phase III PINGS-2 trial.

After 1 year, 67 percent of patients managed with the intervention had a systolic BP of <140 mm Hg, compared with 43 percent of those managed with usual care (p< 0.001), according to Dr Bruce Ovbiagele from the University of California, San Francisco, US, who reported the findings at the European Stroke Organization Conference (ESOC) 2025.

He noted that the strategy involved using basic mobile phones, unlike several previous studies that used smartphones with Bluetooth technology.

“This is a relatively simple, rudimentary approach that we’ve taken, but it is contextually appropriate,” Ovbiagele said during his presentation. “To our knowledge, this is the first large multicentre study of this kind that has been done in the region.”

Stroke poses an immense toll

Ovbiagele stated that stroke exacts a significant burden in sub-Saharan Africa, where resources are scarce, and stroke prevention research is limited. BP control after stroke is exceedingly poor in Ghana, as well as in other parts of Africa. Additionally, mortality rates following stroke also remain high.

He mentioned that this can be attributed to various factors, including the fragmentation of the healthcare system, overburdened workers, a shortage of doctors, and a lack of affordable medications. At the patient level, issues include a lack of understanding regarding how to take medications or how to avoid them when used alongside traditional remedies.

An initial PINGs trial performed by Ovbiagele’s group in Ghana demonstrated the feasibility of utilizing a nurse-guided, mobile phone-based intervention for stroke survivors within a month of symptom onset and hinted at an improvement in BP control. However, the study used smartphones, which had to be loaned to half of the participants. [Stroke 2018;49:236-239]

In the PINGS-2 trial, basic mobile phones were used for the intervention. The study was conducted at 10 hospitals in Ghana and involved 500 patients (mean age 59 years, 43 percent women) who were less than a month out from a haemorrhagic or an ischaemic stroke, had uncontrolled BP (≥140/90 mm Hg), and owned a mobile phone that could receive texts and audio messages. [Ovbiagele B, et al, ESOC 2025]

At baseline, the median NIHSS score was 3, and the median modified Rankin Scale score was 2. Mean BP was approximately 158/95 mm Hg.

Patients were provided with home BP monitors and taught how to use them, while nurses conducted weekly case management assessments. Phone alarms were set as reminders for medication. Additionally, patients and/or caregivers received weekly audio messages that included education on reducing cardiovascular risk. Patients in the usual-care control group also received the weekly audio messages, but not the other components of the intervention.

Systolic BP lower, no difference in diastolic BP

Patients in the intervention group had a significantly lower mean systolic BP than those in the control group at 1 year (138 vs 143 mm Hg; p=0.008) and a greater mean decrease over that period (20 vs 14 mm Hg; p=0.016). There was no difference in diastolic BP, which, according to Ovbiagele, was “a little bit surprising.” The rate of major adverse cardiovascular events, including recurrent strokes, coronary artery disease, and vascular deaths, was not significantly different between the two groups.

Ongoing longer-term follow-up aims to assess the durability of the intervention, as individuals may become fatigued by receiving text messages.