STEPs to Blood Pressure Reduction.
STEPs to Blood Pressure Reduction.
The Stroke Transitions Education and Prevention (STEP) Clinic is a new type of clinic
 designed for stroke patients and was established to provide a comprehensive approach to
 stroke risk factor reduction. The goal of this study will be more effective than usual care
 at reducing blood pressure in patients with poorly controlled blood pressure after an
 ischemic or hemorrhagic stroke or transient ischemic attack.
STEP clinic patients will receive personalized goals, instructions to self-monitor, a blood
 pressure monitor, prescription medications, sleep apnea screening, dietary counseling, and
 more frequent follow-up if needed. A stroke neurologist will see patients in the usual care
 group and recommendations will be sent to their primary care providers.
Inclusion Criteria

 -  Age ≥ 18

 -  Clinical ischemic stroke, intracerebral hemorrhage, or transient ischemic attack

 -  Plan to discharge home or to short stay inpatient rehab after stroke

 -  Two of following required:

 -  History of hypertension (prior to hospitalization)

 -  Hospital blood pressure ≥ 140/90 on two or more occasions during hospitalization

 -  Discharge home on blood pressure medication

 -  Willingness and ability to follow-up in University of Texas Physicians stroke clinic

 Exclusion Criteria:

 -  Modified Rankin scale (mRs) > 3 at enrollment

 -  Terminal illness

 -  Chronic kidney disease stage 4 or greater (eGFR < 30)

 -  Pregnancy

 -  Symptomatic flow limiting carotid stenosis without plan for intervention prior to
 clinic visit

 -  Stroke etiology presumed unrelated to atherosclerotic risk factors (amyloid
 angiopathy, vasculitis, malignancy associated)