- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00229242
Comparison of Diuretic-based With Non-diuretic Based Hypertension Therapy Using Echocardiographic Measures
December 11, 2009 updated by: Queen's University
MAIN: The benefits of treating high blood pressure successfully to normal levels on heart function are the same regardless of which particular combination of drugs are used.
SECONDARY: Measurement of heart function using a comprehensive ultrasound imaging method (Echocardiography) and an objective test of functional ability are better predictors of changes in heart function with successful hypertension treatment, than subjective signs of heart failure.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Successful treatment of hypertension with single medications is very rare.
On average successful treatment requires more than 2 medications.
These medications work by different methods.
One of the ideas behind the use of combinations of medication for hypertension is that benefits are additive.
There are unresolved questions about whether the observed benefits are simply related to effective treatment of hypertension, or whether some of the medications have special benefits independent of blood pressure lowering.
Each of these contentions has been justified by clinical trials.
However these trials have in common the flaw that hypertension is either not effectively controlled in all the treated subjects, or the magnitude of blood pressure change after treatment is different in the groups compared.
The result of one of the largest blood pressure clinical trials called ALLHAT trial has recently fuelled this debate.
The ALLHAT trial which utilized only subjective symptoms and signs of heart failure, called the FRAMINGHAM score, to determine who has abnormal heart function, implied that diuretics (water pills) were superior to the newer drugs in reducing the frequency of abnormal heart function.
This study shared the flaw of previous trials in not having equal blood pressure lowering in the groups.
Nevertheless it provided some evidence that argued against the notion that newer drugs were better than older drugs like diuretics.
Shortly after the publication of ALLHAT, another trial called ANBP was published showing that the group of drugs that was least effective in ALLHAT was superior to diuretics in preventing important cardiovascular outcomes.
Hence, it is not currently clear that there are differences between various drug combinations, if effective and equal blood pressure lowering is achieved.
Another finding that may have confounded clinical trials that rely on subjective scores of heart dysfunction such as the ALLHAT, is that a significant proportion of subjects with advanced heart disease are unaware of their heart problem and hence will probably not seek attention.
This raises the concern that the true frequency of abnormal heart function might not have been reported in those studies.
Using more modern tools such as Echocardiography, a more complete assessment of heart dysfunction can be obtained.
In addition objective tests of heart function such as the 6-minute walk distance could yield a more reliable assessment of any worsening or improvement in heart function if performed serially in treated subjects.
In view of the above discussion, only a study in which hypertension is effectively and similarly controlled could be used to answer the questions regarding different effects of various drug combinations.
Such is this study proposed.
Study Type
Interventional
Enrollment (Actual)
38
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Ontario
-
Kingston, Ontario, Canada, K7L 2V7
- Kingston General Hospital
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
15 years to 65 years (Child, Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Age 20-65 years;
- Hypertension with average 24-hour BP of >130 mmHg systolic or >80 mmHg diastolic in spite of treatment with one medication;
- Office systolic blood pressure >140 mmHg and less than 180mmHg;
- Able to comprehend and sign the consent form;
- Able to tolerate either hydrochlorothiazide 25 mg or amlodipine 5 mg daily for 3 weeks during the run-in phase.
Exclusion Criteria:
- Diagnosis of secondary hypertension;
- Hypertension with systolic BP >180 mmHg in spite of 1 medication;
- Chronic heart failure requiring diuretics, Angina or coronary syndrome requiring anti-angina therapy with CCB or beta blockers, or more than 0.4 mg/hr nitroglycerine patch;
- Left Ventricular Ejection Fraction (LVEF) <20% or LV end systolic dimension >75 mm;
- Significant valvular disease such as; more than mild disease of aortic or mitral valve;
- Technically sub-optimal acoustic window or regional wall motion abnormalities;
- Patients currently on both CCB and diuretics for more than 4 weeks;
- Normal 24 hour ABPM at the end of the run-in period;
- Physical handicap that precludes adequate performance of 6-minute walk such as arthritis;
- Concomitant comorbidity that might compromise ability to evaluate treatment or enhance risks of therapy, such as: atrial fibrillation with resting ventricular rate of >100 bpm; morbid obesity; uncontrolled diabetes mellitus; severe chronic obstructive pulmonary disease (COPD); hypertrophic cardiomyopathy; and documented history of non-compliance with treatment;
- Any condition or disorder other than hypertension that: Requires prolonged hospitalization; May limit life expectancy within 2 years; would increase the risk of participation to the subject (in the opinion of the investigator).
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: 1
Diuretic-Based Hypertension Therapy
|
|
Active Comparator: 2
Non-Diuretic-Based Hypertension Therapy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Measurement of systolic and diastolic function in responders to therapy
Time Frame: 0, 3 and 6 months
|
0, 3 and 6 months
|
LV mass in responders
Time Frame: 0, 3 and 6 months
|
0, 3 and 6 months
|
Change in 6-minute walk distance in responders
Time Frame: 0, 3, and 6 months
|
0, 3, and 6 months
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Correlation between interval improvement or deterioration in Framingham score and corresponding change in echocardiographic classification in all subjects
Time Frame: 3 and 6 months
|
3 and 6 months
|
Correlation between interval improvement or deterioration in LV Mass and corresponding change in 6 minute walk distance and diastolic function in all subjects
Time Frame: 3 and 6 months
|
3 and 6 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Kofo O Ogunyankin, MD, FACC, Queen's University
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
November 1, 2003
Primary Completion (Actual)
December 1, 2006
Study Completion (Actual)
March 1, 2007
Study Registration Dates
First Submitted
September 13, 2005
First Submitted That Met QC Criteria
September 27, 2005
First Posted (Estimate)
September 29, 2005
Study Record Updates
Last Update Posted (Estimate)
December 14, 2009
Last Update Submitted That Met QC Criteria
December 11, 2009
Last Verified
December 1, 2009
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- DMED-676-03
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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