Clinical Short Communication Short-term pilot feasibility study of a nurse-led intervention to improve blood pressure control after stroke in Nigeria Kolawole Wasiu Wahab a, ⁎, Mayowa Owolabi b , Rufus Akinyemi b , Carolyn Jenkins c , Oyedunni Arulogun d , Onoja Akpa e , Mulugeta Gebregziabher f , Ezinne Uvere b , Raelle Saulson g , Bruce Ovbiagele g a Department of Medicine, University of Ilorin, Ilorin, Nigeria b Department of Medicine, University of Ibadan, Ibadan, Nigeria c Department of Nursing, Medical University of South Carolina, Charleston, USA d Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria e Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria f Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA g Department of Neurology, Medical University of South Carolina, Charleston, USA abstract article info Article history: Received 9 February 2017 Received in revised form 2 April 2017 Accepted 5 April 2017 Available online 07 April 2017 Background: Given the paucity of neurologists in Sub-Saharan Africa (SSA), task-shifting post-stroke care to nurses could be a viable avenue for enhancing post-stroke outcomes. This pilot study assessed the feasibility and short-term impact of a nurse-led intervention to manage blood pressure (BP) control in recent stroke survivors in Nigeria. Methods: A randomized pilot trial allocated patients within one month of an index stroke from two participating hospitals in Nigeria to either nurse-led group clinic or standard care for 14 days. Key study endpoints were successful execution of the protocol, subject retention, and short-term BP effects. Results: There were no significant differences between the intervention (n = 17) and control (n = 18) groups at baseline. At the post-intervention clinic, patient retention rate was 100%. In the intervention group, both the systolic and diastolic BPs measured at home were lower than the clinic BPs post-interven- tion (127 ± 12.88/78.13 ± 19.26 mmHg versus 137.50 ± 23.05/84.06 ± 9.67 mmHg; p = 0.05). However, there was no significant change in clinic blood pressure (BP) recordings in both the intervention and control groups. Conclusion: It is possible to initiate a nurse-led group clinic intervention to address BP management among stroke survivors in SSA with good early retention of participants. A larger and longer-term trial is being planned. © 2017 Elsevier B.V. All rights reserved. Keywords: Stroke Blood pressure Task shifting Nurse-led group clinic Sub-Saharan Africa 1. Introduction Stroke is a major contributor to death, disability, and dementia in Sub-Saharan Africa (SSA) [1,2]. By far the most powerful modifiable stroke risk factor is hypertension (HTN) [3,4], and uncontrolled HTN after a stroke is a major predictor of recurrence [5–10]. Only 4 out of every 10 patients with HTN evaluated at least one month after stroke in a Nigerian study had good blood pressure control [11]. Sub-optimal HTN control poses a serious challenge for stroke prevention [12–14], thus achieving optimal blood pressure (BP) control needs to be at the center of any serious effort to lessen the burden of stroke in SSA. However, control of stroke risk factors in many SSA countries is quite challenging due to uncoordinated care and a shortage in the number of qualified physicians, among other factors [15]. One potential solution to limited healthcare access in SSA is task- shifting, i.e. training non-physician healthcare workers to perform tasks traditionally undertaken by physicians [16] and our group has a recent evidence of its feasibility and utility in stroke care. Nurses may be potential alternatives to improve access to care in settings where physicians are few or not available [17]. In SSA, nurse-led care programs have been successfully implemented for chronic infectious diseases [18], and chronic non-infectious condi- tions such as epilepsy, asthma, diabetes, and HTN in primary care settings [19,20]. However, in spite of the huge burden of stroke in SSA, nurse-led clinics have not been tested for impact through controlled trials [21]. Journal of the Neurological Sciences 377 (2017) 116–120 ⁎ Corresponding author at: Department of Medicine, University of Ilorin, PO Box 738, Ilorin 240001, Nigeria. E-mail address: wahab.kw@unilorin.edu.ng (K.W. Wahab). http://dx.doi.org/10.1016/j.jns.2017.04.005 0022-510X/© 2017 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect Journal of the Neurological Sciences journal homepage: www.elsevier.com/locate/jns