- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01994408
Default BP Medication Intensification
January 30, 2017 updated by: Florian Rader, MD, MSc, Cedars-Sinai Medical Center
Automatic Medication Increase Protocol in the Treatment of Elevated Blood Pressure
High blood pressure leads to heart attacks and strokes which can be prevented by blood pressure-lowering medication.
However, the current office-based prescription of one pill and one dose at a time is ineffective.
the investigators want to pilot-test a more effective patient-centered treatment approach, where patients will receive a prescription with gradual but automatic weekly increases of dose and number of pills.
Patients will measure their blood pressure with an iPhone compatible cuff, which transmits readings to the doctor or pharmacist, who will stop escalation when the desired blood pressure level is reached.
The investigators hypothesize that the intervention will decrease the time to control blood pressure and increase the overall rate of blood pressure control.
Therefore, this new treatment model could prevent heart attacks and strokes, and reduce healthcare costs.
Study Overview
Detailed Description
This is a pilot 2A trial of an innovative behavioral economics theory-based antidote for physician inertia in the medical treatment of hypertension (HTN).
In the current reactive physician-centered model, blood pressure (BP) is measured and medical decisions are made in the physician office; when deciding whether or not to prescribe new medication for a high office BP reading, the physician's default behavior is inaction.
The investigators propose default medication intensification as a new patient-centered/pharmacist-assisted proactive treatment model to eliminate physician inertia.
For enrolled patients with office BP>155/95, the physician will prescribe a one-month protocol that automatically escalates drug dose and drug number each week.
The pharmacist will fill the prescription in a blister pack to simplify adherence.
The patient will measure daily home BP with an iPhone cuff that transmits the data electronically to the pharmacist, who will halt the protocol if goal home BP<135/85 is achieved ahead of schedule.
the investigators will pilot test the feasibility and safety of self-monitoring plus the new automatic intensification protocol packaged in blisters.
Default medication intensification could revolutionize HTN treatment and reduce healthcare costs.
Study Type
Interventional
Enrollment (Actual)
3
Phase
- Phase 2
- Phase 1
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
-
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California
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Los Angeles, California, United States, 90048
- Cedars-Sinai Medical Center
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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
18 years to 55 years (Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- 18 to 55 years old
- office BP of ≥160 mmHg systolic and ≥100 mmHg diastolic (treated or untreated) AND <180 mmHg systolic.
Exclusion Criteria:
- chronic kidney disease
- symptomatic coronary artery disease
- congestive heart failure
- more than mild valvular heart disease
- Diabetes mellitus
- obstructive left ventricular hypertrophy
- severe electrolyte abnormalities
- multiple medication intolerances
- orthostatic hypotension
- cognitive impairment and mental disorders affecting ability to self-monitor BP
- patients who are unwilling to measure and transmit BP readings throughout the study
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: Other
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: default intensification arm (all)
all subjects will receive blister packs with weekly increasing blood pressure medications.
There is no control arm for this study
|
The investigators will determine which blood pressure medications to use.
No specific drug will be tested but rather the automatic intensification of medications is the intervention.
Examples of drugs used in this study are calcium channel blockers (e.g., amlodipine 2.5 mg to 10 mg) or ACE-inhibitors (e.g., lisinopril 5 mg to 40 mg) or diuretics (HCTZ 25 mg).
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Symptomatic hypotension
Time Frame: from enrollment to 12 weeks
|
Primary safety outcome is symptomatic hypotension during study participation (12 weeks).
Safety monitoring will be achieved with patient-directed iPhone-based BP measuring and transmitting to study staff.
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from enrollment to 12 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
hypertension control rate
Time Frame: at 12 weeks
|
The investigators will assess blood pressure throughout the study period (12 weeks) with iPhone based technology.
Hypertension control is defined as home blood pressure <135/85 mmHg
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at 12 weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
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.
General Publications
- Phillips LS, Branch WT, Cook CB, Doyle JP, El-Kebbi IM, Gallina DL, Miller CD, Ziemer DC, Barnes CS. Clinical inertia. Ann Intern Med. 2001 Nov 6;135(9):825-34. doi: 10.7326/0003-4819-135-9-200111060-00012.
- O'Connor PJ. Overcome clinical inertia to control systolic blood pressure. Arch Intern Med. 2003 Dec 8-22;163(22):2677-8. doi: 10.1001/archinte.163.22.2677. No abstract available.
- Green BB, Cook AJ, Ralston JD, Fishman PA, Catz SL, Carlson J, Carrell D, Tyll L, Larson EB, Thompson RS. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA. 2008 Jun 25;299(24):2857-67. doi: 10.1001/jama.299.24.2857. Erratum In: JAMA. 2009 Nov 11;302(18):1972.
- Bray EP, Holder R, Mant J, McManus RJ. Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials. Ann Med. 2010 Jul;42(5):371-86. doi: 10.3109/07853890.2010.489567.
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, 2013
Primary Completion (Actual)
September 1, 2015
Study Completion (Actual)
December 1, 2015
Study Registration Dates
First Submitted
November 12, 2013
First Submitted That Met QC Criteria
November 22, 2013
First Posted (Estimate)
November 25, 2013
Study Record Updates
Last Update Posted (Estimate)
February 1, 2017
Last Update Submitted That Met QC Criteria
January 30, 2017
Last Verified
January 1, 2017
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Pro00030558
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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