To identify barriers and facilitators to post-stroke blood pressure (BP) control among a diverse group of stroke survivors.

Blood pressure (BP) reduction is the most important opportunity for secondary stroke prevention. Despite the benefit of controlling BP after stroke, many patients fail to achieve adequate control. For instance, >60% of patients with stroke discharged from our institution have uncontrolled BP. In October 2023, the Yale Patient & Family Advisory Council (PFAC) was assembled to understand barriers to post-stroke BP control and opportunities for improvement.

Patients with ischemic and hemorrhagic stroke were recruited to participate along with their care-partners in the PFAC. Patients were reimbursed monetarily for their time. Segments of agenda-driven meetings utilized semi-structured interviewing techniques. Discussions were recorded, transcribed, and analyzed according to the framework method to identify key themes related to post-stroke BP control.

Twelve stroke survivors were enrolled in the PFAC (33% female; 33% Black, 9% Hispanic, 56% White; mean age 62 years old). Meetings were held over a video platform. Survivors reported “information overload,” reduced concentration, increased anxiety, and impaired ability to retain information delivered during their hospitalization. There was value for care-partner involvement, noting that the support of family members was essential for reinforcing BP management strategies. Lastly, survivors identified peer support as the most promising BP intervention that would overcome barriers specific to stroke survivors. Members recommended programs to be held in community locations (libraries or gyms) to foster comfort and accessibility compared to clinical environments. There was also preference for conversational discussion over lectures to promote mutual learning and engagement.

Listening and engaging with stroke survivors identified barriers to BP control as well as a preferred intervention for overcoming the unique barriers faced by patients with stroke. Next steps include tailoring the peer support program in partnership with the PFAC and the local community.