- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02142881
Treatment of Masked Hypertension
December 27, 2017 updated by: University of Minnesota
To date, most observational and all intervention studies have defined hypertension on the basis of clinic blood pressure (BP).
Measurement of BP outside the clinic with home or ambulatory BP provides a better estimate of the risk of cardiovascular disease and all-cause mortality.
Using clinic and ambulatory BPs, patients can be categorized as normotensive (normal clinic and ambulatory BPs), white-coat hypertension (elevated clinic BP with normal ambulatory BP), masked hypertension (normal clinic BP with elevated ambulatory BP), and sustained hypertension (elevated clinic and ambulatory BP).
Approximately one third of patients with chronic kidney disease (CKD) with normal clinic BP have elevated ambulatory BP (masked hypertension).
We demonstrated that, among participants from the Chronic Renal Insufficiency Cohort (CRIC) study, low estimated glomerular filtration rate (eGFR) and elevated proteinuria are associated with increased odds of masked hypertension.
Additionally, participants with masked hypertension had increased risk for target organ damage as assessed by left ventricular mass and pulse wave velocity.
These results in participants with CKD are consistent with prior studies in patients with normal renal function that demonstrated a two-fold increased risk for cardiovascular events in patients with masked hypertension compared to patients with normal clinic and ambulatory BP.
Despite this elevated risk for adverse outcomes, patients with masked hypertension have been excluded from hypertension trials because of their normal clinic BP.
Therefore, it is unknown whether the reduction in target organ damage and adverse cardiovascular outcomes associated with treatment of hypertension extends to patients with masked hypertension.
To address this important gap in knowledge, we are planning a randomized, controlled trial to evaluate whether antihypertensive treatment can modify BP patterns in patients with masked hypertension, that is, convert them to controlled clinic and ambulatory BP.
We will also evaluate the effect antihypertensive treatment on target organ damage in patients with masked hypertension.
The current study is a pilot randomized controlled trial to evaluate the feasibility of the planned trial and the effect of antihypertensive therapy on clinic and ambulatory BP, proteinuria, and target organ damage in patients with masked hypertension.
Study Overview
Status
Completed
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
4
Phase
- Phase 3
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
-
-
Minnesota
-
Minneapolis, Minnesota, United States, 55414
- University of Minnesota
-
-
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 75 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Age 18-75 years
- 30 < eGFR < 70 ml/min/1.73m2 within 9 months of the screening visit
- Urine albumin to creatinine ratio >100mg/gm OR a urinalysis with ≥30mg/dL albuminuria within 9 months of the screening visit
- Most recent clinic systolic BP >120 and <140 mmHg within 9 months of the screening visit
- Masked hypertension at the screening and baseline visits
- Clinic systolic BP <140 mmHg
- 24hr ambulatory systolic BP > 130 mmHg
- Taking ≤ 2 antihypertensive medications
- No change in antihypertensive medications for the past 6 months
Exclusion Criteria:
- Heart failure
- Lightheaded with standing
- Loss of consciousness in the past 24 months
- Non-English speakers
- History of breast cancer requiring a mastectomy or radiation on the side of the non-dominant arm and unable or refuses to use the dominant arm for ambulatory BP monitoring
- Cardiovascular event or procedure or hospitalization for unstable angina within the last 3 months
- Inability to perform ambulatory BP monitoring due to compliance or other clinical reason
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 |
---|---|
Other: Usual care
|
Antihypertensive medications will be adjusted by the participants' providers (usual care).
|
Experimental: Antihypertensive medication intensification
|
Antihypertensive medications will be adjusted by study staff based on ambulatory and clinic BP results at baseline and 2 months with a target 24hr systolic blood pressure of <130 mmHg.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of participants with masked hypertension
Time Frame: 4 months
|
Percentage of participants with masked hypertension defined as a 24hr ambulatory systolic blood pressure >130 mmHg and a clinic systolic blood pressure <140 mmHg
|
4 months
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Change from baseline in urine albumin to creatinine ratio at 4 months
Time Frame: Baseline, 4 months
|
Baseline, 4 months
|
Change from baseline in pulse wave velocity at 4 months
Time Frame: Baseline, 4 months
|
Baseline, 4 months
|
Change from baseline in 24hr ambulatory systolic blood pressure at 4 months
Time Frame: Baseline, 4 months
|
Baseline, 4 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of participants with masked hypertension
Time Frame: 2 months
|
Percentage of participants with masked hypertension defined as a 24hr ambulatory systolic blood pressure >130 mmHg and a clinic systolic blood pressure <140 mmHg
|
2 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Paul E Drawz, MD, MHS, MS, University of Minnesota
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
June 1, 2014
Primary Completion (Actual)
December 7, 2017
Study Completion (Actual)
December 7, 2017
Study Registration Dates
First Submitted
May 16, 2014
First Submitted That Met QC Criteria
May 19, 2014
First Posted (Estimate)
May 20, 2014
Study Record Updates
Last Update Posted (Actual)
December 29, 2017
Last Update Submitted That Met QC Criteria
December 27, 2017
Last Verified
December 1, 2017
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1404M49925
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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