{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:51:54Z","timestamp":1788245514029,"version":"build-2803163510"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2026,6,16]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Addressing the rising burden of stroke in low-income countries will require pragmatic and scalable interventions targeting major risk factors. Under routine care settings, &lt;10% of adults living with hypertension ever achieve blood pressure control, accentuating risks for adverse vascular events. The effectiveness of mobile health\u2013centered, nurse-led interventions for the control of hypertension among patients with recent stroke in a resource-limited African setting is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>The PINGS (Phone-Based Intervention Under Nurse Guidance After Stroke II) 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 \u226518 years with stroke within 1 month of onset and elevated blood pressure \u2265140 or \u226590 mm\u2009Hg. The primary outcome was systolic blood pressure &lt;140 mm\u2009Hg at month 12 by intention-to-treat principle. Secondary outcomes included major adverse cardiovascular events and serious adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      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 \u20135.5 mm\u2009Hg (95% CI, \u20139.6 to \u20131.4 mm\u2009Hg;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =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%\u201333%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;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 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.12).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Leveraging mobile health intervention with minimal sophistication and task shifting to nurses on top of usual care safely improved blood pressure control among stroke survivors in a low-resource setting. Further study is warranted to confirm these findings and understand outcome drivers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT04404166.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.125.077424","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T09:00:13Z","timestamp":1775725213000},"page":"1890-1902","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Phone-Based Intervention Under Nurse Guidance for Control of Hypertension After Stroke: A Randomized Multicenter Phase 3 Trial in Ghana"],"prefix":"10.1161","volume":"153","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7274-5093","authenticated-orcid":true,"given":"Fred Stephen","family":"Sarfo","sequence":"first","affiliation":[{"name":"Kwame Nkrumah University of Science and Technology (F.S.S., S.B.N., N.K.A.-B., L.T.A., P.A.O.-A., S. Adamu, M. Agbenorku, J.H.A.), Kumasi, Ghana."},{"name":"Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.S., L.T.A., P.A.O.-A., S. Adamu, M. Agbenorku, N.A.-M., M. Ampofo, S.O.A., N.A.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4802-9852","authenticated-orcid":true,"given":"Albert","family":"Akpalu","sequence":"additional","affiliation":[{"name":"University of Ghana Medical School, Accra (A.A., R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1173-1493","authenticated-orcid":true,"given":"Ansumana S.","family":"Bockarie","sequence":"additional","affiliation":[{"name":"University of Cape Coast, Ghana (A.S.B., E.M., V.A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2118-7711","authenticated-orcid":true,"given":"Samuel Blay","family":"Nguah","sequence":"additional","affiliation":[{"name":"Kwame Nkrumah University of Science and Technology (F.S.S., S.B.N., N.K.A.-B., L.T.A., P.A.O.-A., S. Adamu, M. Agbenorku, J.H.A.), Kumasi, Ghana."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0961-4434","authenticated-orcid":true,"given":"Nana Kwame","family":"Ayisi-Boateng","sequence":"additional","affiliation":[{"name":"Kwame Nkrumah University of Science and Technology Hospital (N.K.A.-B.), Kumasi, Ghana."},{"name":"Kwame Nkrumah University of Science and Technology (F.S.S., S.B.N., N.K.A.-B., L.T.A., P.A.O.-A., S. Adamu, M. Agbenorku, J.H.A.), Kumasi, Ghana."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6886-8557","authenticated-orcid":true,"given":"Rexford","family":"Adu Gyamfi","sequence":"additional","affiliation":[{"name":"Agogo Presbyterian Hospital, Ghana (R.A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes Amankwaah","family":"Arthur","sequence":"additional","affiliation":[{"name":"Ankaase Methodist Faith Hospital, Ghana (A.A.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiana","family":"Duah","sequence":"additional","affiliation":[{"name":"Kumasi South Hospital, Ghana (C.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Fiattor","sequence":"additional","affiliation":[{"name":"Manhyia District Hospital, Kumasi, Ghana (T.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1912-8939","authenticated-orcid":true,"given":"Kwadwo Gyebi","family":"Agyenim-Boateng","sequence":"additional","affiliation":[{"name":"Kwadaso Seventh Day Adventist Hospital, Kumasi, Ghana (K.G.A.-B.)."},{"name":"Tafo Government Hospital, Kumasi, Ghana (E.A., K.A.B., S. Adu)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Achab","sequence":"additional","affiliation":[{"name":"Tafo Government Hospital, Kumasi, Ghana (E.A., K.A.B., S. Adu)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8895-2000","authenticated-orcid":true,"given":"Lambert Tetteh","family":"Appiah","sequence":"additional","affiliation":[{"name":"Kwame Nkrumah University of Science and Technology (F.S.S., S.B.N., N.K.A.-B., L.T.A., P.A.O.-A., S. Adamu, M. Agbenorku, J.H.A.), Kumasi, Ghana."},{"name":"Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.S., L.T.A., P.A.O.-A., S. Adamu, M. Agbenorku, N.A.-M., M. Ampofo, S.O.A., N.A.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2194-775X","authenticated-orcid":true,"given":"Priscilla Abrafi","family":"Opare-Addo","sequence":"additional","affiliation":[{"name":"Kwame Nkrumah University of Science and Technology (F.S.S., S.B.N., N.K.A.-B., L.T.A., P.A.O.-A., S. Adamu, M. Agbenorku, J.H.A.), Kumasi, Ghana."},{"name":"Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.S., L.T.A., P.A.O.-A., S. Adamu, M. Agbenorku, N.A.-M., M. Ampofo, S.O.A., N.A.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0053-2114","authenticated-orcid":true,"given":"Sheila","family":"Adamu","sequence":"additional","affiliation":[{"name":"Kwame Nkrumah University of Science and Technology (F.S.S., S.B.N., N.K.A.-B., L.T.A., P.A.O.-A., S. Adamu, M. Agbenorku, J.H.A.), Kumasi, Ghana."},{"name":"Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.S., L.T.A., P.A.O.-A., S. 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