REducing Blood Pressure Variability in Essential Hypertension With RAmipril vErsus Nifedipine GITS Trial (REVERENT)

September 29, 2021 updated by: Istituto Auxologico Italiano

Short - Medium and Long Term Blood Pressure Variability in Essential Hypertensive Patients Treated With Nifedipine GITS or Ramipril - a Randomized Trial

The purpose of this study is

  1. to compare the effects of nifedipine GITS and ramipril on blood pressure variability in subjects with elevated blood pressure variability.
  2. to assess whether the degree of treatment-induced changes in blood pressure variability, is related to the degree of regression (or progression) of organ damage in heart, kidneys and carotid arteries.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Elevated blood pressure variability (BPV) is associated with adverse cardiovascular outcomes and organ damage in hypertensive subjects. An antihypertensive treatment able to reduce BPV independently of BP lowering effect might thus provide additional protection in terms of cardiovascular risk in subjects with elevated BPV, independently on its effect of BP itself. However, data on the effects of different classes of antihypertensive drugs on BPV are limited and inconsistent. Some studies have suggested a possible usefulness of calcium antagonists in this setting. Based on the above considerations the investigators hypothesize that a calcium channel blocker nifedipine GITS, will provide a greater BPV lowering effect, when compared with ramipril, independently from the reduction in mean BP level. Based on the above considerations, the primary objective of this study is to compare the effects of nifedipine GITS and ramipril on different estimates of BPV (24 h BPV, home BPV, and visit-to-visit BPV) in subjects with elevated BPV. The secondary objective is to assess whether the degree of treatment-induced changes in BPV, is related to the degree of regression (or progression) of organ damage, after accounting for mean BP reduction by treatment.

Study Type

Interventional

Enrollment (Actual)

168

Phase

  • Phase 4

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

  • China
      • Shanghai, China
        • Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine
  • Greece
      • Athens, Greece
        • Hypertension Center, Third University Department of Medicine, Sotiria Hospital
  • Italy
      • Milan, Italy
        • Istituto Auxologico Italiano

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

35 years to 75 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Male and female subjects
  • Age 35-75 years
  • Clinic systolic BP ≥140 mmHg and/or diastolic BP ≥ 90 mmHg (under no antihypertensive treatment)
  • Daytime BP on ambulatory BP monitoring (ABPM) ≥135 mmHg systolic and/or ≥85 mmHg diastolic (under no antihypertensive treatment)
  • Home SBP standard deviation (SD) >7 mmHg and/or daytime ambulatory SBP SD >12 mmHg
  • Patients may be included if untreated or, if treated with one antihypertensive drug or two drugs in low doses, after 2 weeks' washout period
  • Written informed consent to participate in the study

Exclusion Criteria:

  • Subjects treated with ≥ 2 antihypertensive drugs (except those on two drugs in low doses)
  • Treated subjects with on-treatment clinic BP ≥160 mmHg systolic and/or 100 mmHg diastolic
  • Treated antihypertensive subjects in whom withdrawal of treatment is deemed unethical by the investigator (e.g. because of the existence of compelling indications other than hypertension for continuous use of previously used antihypertensive agent)
  • Contraindications to study treatments as detailed in the relative Summaries of Medical Product Characteristics for ramipril (hypersensitivity to ramipril or any of the excipients or any other ACE inhibitor, history of angioneurotic oedema, extracorporeal treatments leading to contact of blood with negatively charged surfaces, significant bilateral renal artery stenosis or renal artery stenosis in a single functioning kidney, second and third trimesters of pregnancy, lactation, haemodynamically relevant renal artery stenosis, hypotensive or haemodynamically unstable patients) or nifedipine GITS (known hypersensitivity to nifedipine or to any of the excipients, pregnancy before week 20 and during breastfeeding, cardiovascular shock, concomitant treatment with rifampicin, patients with a Kock pouch)
  • Cardiovascular diseases other than hypertension (coronary heart disease, heart failure or left ventricular systolic dysfunction of any degree, atrial fibrillation or frequent arrhythmias, valvular or congenital heart disease, cardiomyopathies, cerebrovascular disease, peripheral artery disease, aortic aneurysm)
  • Chronic kidney disease
  • Suspected or confirmed secondary hypertension
  • Diabetes mellitus
  • Subjects with conditions other than those mentioned above, where compelling indications for the use of any specific class of antihypertensive medication exist, according to current (e.g. European Society of Cardiology) guidelines
  • Other conditions deemed relevant by the investigator (including respiratory disorders, liver disease, renal disease, thyroid disorders)
  • BMI ≥35 kg/m2
  • Known severe obstructive sleep apnea (apnea-hypopnea index > 30 or use of CPAP)
  • Premenopausal women not using effective contraceptive methods
  • Elevated probability of noncompliance with the study procedures

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: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Nifedipine GITS 30 mg slow release
Nifedipine GITS 30 mg slow release in tablets.
Drug: Nifedipine GITS
Commercially available drug formulations are used. Study medication will be assumed in a single morning (7-10 a.m.) administration per os.
Experimental: Ramipril 10 mg
Ramipril 10 mg in tablets.
Drug: Ramipril
Commercially available drug formulations are used. Study medication will be assumed in a single morning (7-10 a.m.) administration per os.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Variability (standard deviation) of home systolic blood pressure at final visit
Time Frame: After 10 weeks of study treatment
After 10 weeks of study treatment

Secondary Outcome Measures

Outcome Measure
Time Frame
Variability (standard deviation) of home diastolic blood pressure measured at final visit
Time Frame: At baseline and after 10 weeks of study treatment
At baseline and after 10 weeks of study treatment
Short term 24h variability of systolic blood pressure at final visit (24h weighted standard deviation)
Time Frame: At baseline and after 10 weeks of study treatment
At baseline and after 10 weeks of study treatment
Short term 24h variability of diastolic blood pressure at final visit (24h weighted standard deviation)
Time Frame: At baseline and after 10 weeks of study treatment
At baseline and after 10 weeks of study treatment
Visit-to-visit variability (standard deviation) of systolic blood pressure assessed over the three last visits
Time Frame: At baseline and after 6, 8 and 10 weeks of study treatment
At baseline and after 6, 8 and 10 weeks of study treatment
Visit-to-visit variability (standard deviation) of diastolic blood pressure assessed over the three last visits
Time Frame: At baseline and after 6, 8 and 10 weeks of study treatment
At baseline and after 6, 8 and 10 weeks of study treatment
Mean 24 hour systolic blood pressure at final visit
Time Frame: At baseline and after 10 weeks of study treatment
At baseline and after 10 weeks of study treatment
Mean 24 hour diastolic blood pressure at final visit
Time Frame: At baseline and after 10 weeks of study treatment
At baseline and after 10 weeks of study treatment
Sokolow index at the end of the extension study
Time Frame: At baseline and after 12 months of study treatment
At baseline and after 12 months of study treatment
Cornell voltage duration index at the end of the extension study
Time Frame: At baseline and after 12 months of study treatment
At baseline and after 12 months of study treatment
Left ventricular mass index at the end of the extension study
Time Frame: At baseline and after 12 months of study treatment
At baseline and after 12 months of study treatment
Microalbuminuria (albumin-creatinine ratio) at the end of the extension study
Time Frame: At baseline and after 12 months of study treatment
At baseline and after 12 months of study treatment
Estimated glomerular filtration rate (eGFR, by CKD-EPI formula) at the end of the extension study
Time Frame: At baseline and after 12 months of study treatment
At baseline and after 12 months of study treatment
Carotid-femoral pulse wave velocity (cfPWV) at the end of the extension study
Time Frame: At baseline and after 12 months of study treatment
At baseline and after 12 months of study treatment

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Istituto Auxologico Italiano

Collaborators

Bayer

Investigators

  • Principal Investigator: Gianfranco Parati, MD, Istituto Auxologico Italiano - Milan, Italy

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

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

October 1, 2015

Primary Completion (Actual)

July 3, 2020

Study Completion (Actual)

November 1, 2020

Study Registration Dates

First Submitted

July 10, 2015

First Submitted That Met QC Criteria

July 14, 2015

First Posted (Estimate)

July 16, 2015

Study Record Updates

Last Update Posted (Actual)

September 30, 2021

Last Update Submitted That Met QC Criteria

September 29, 2021

Last Verified

September 1, 2021

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 09F401

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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