Blood Pressure Control Target in Diabetes (BPROAD)

Blood Pressure Control Target in Diabetes (BPROAD): a Multicenter, Open-label, Parallel-group, Randomized Controlled Trial

This is a multicenter, open-label, parallel-group, randomized controlled trial that will be conducted across mainland China. This trial will test the primary hypothesis of whether an intensive treatment strategy (a systolic blood pressure target of <120 mmHg) is more effective than a standard treatment strategy (a systolic blood pressure target of <140 mmHg) in reducing the risk of major cardiovascular disease (non-fatal stroke, non-fatal myocardial infarction, treated or hospitalized heart failure, and cardiovascular deaths) over a follow-up period of up to 5 years among patients with a history of diabetes and elevated systolic blood pressure. The secondary hypotheses are to compare the intensive blood pressure treatment strategy with the standard treatment strategy on cognitive function, individual components of the primary hypothesis, all-cause mortality, kidney outcomes, quality of life, and injurious falls, et al.

Study Overview

• Status: Completed
• Conditions: Blood Pressure Control Target in Diabetes
• Intervention / Treatment: Other: Treatment strategy regarding different systolic BP goals

Detailed Description

The trial will recruit 12,702 patients from approximately 150 hospitals within the China Diabetes Clinical Research Network. Eligible criteria include men and women aged ≥50 years; type 2 diabetes mellitus; elevated systolic blood pressure; and a history of clinical cardiovascular disease or increased risk for cardiovascular disease. Main exclusion criteria include known secondary cause of hypertension, symptomatic heart failure, end-stage renal disease, and other serious illness. The proposed trial has 90% statistical power to detect a 20% reduction (hazard ratio of 0.80) in major cardiovascular disease between intensive and standard treatment groups at a 2-sided significance level of 0.05.

To achieve the proposed study objectives, the following specific aims will be accomplished:

1. Recruit 12,702 study participants who meet the eligibility criteria and randomly assign 6,351 to the intensive blood pressure treatment and 6,351 to the standard blood pressure treatment groups;
2. Achieve and maintain two-level targets of systolic blood pressure (<120 mmHg vs. <140 mmHg) with a mean systolic blood pressure difference of ≥15 mmHg;
3. Employ a study-wide strategy to encourage standard of care for all participants for the treatment of type 2 diabetes and dyslipidemia other than blood pressure;
4. Obtain clinical data on study outcomes for up to 60 months of follow-up among all trial participants;
5. Perform strict quality control procedures for intervention and data collection;
6. Conduct data analysis according to the intention-to-treat principle; and
7. Disseminate the study findings to influence clinical practice and clinical guidelines.

Findings from this trial will provide evidence as to whether intensive blood pressure management to achieve a systolic blood pressure target of <120 mmHg has additional benefits over standard management of systolic blood pressure <140 mmHg. These findings will help in the development of clinical guidelines for blood pressure management among patients with type 2 diabetes and will have important clinical impact.

• Study Type: Interventional
• Enrollment (Actual): 12821
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Shanghai
    • Shanghai, Shanghai, China, 200025
      • Ruijin Hospital, Shanghai Jiaotong University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Men and women aged ≥50 years;

2. Diabetes defined as:

   • A self-reported previous diagnosis by health care professionals and taking anti-diabetic medications;
   • Fasting plasma glucose level of ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 hours;
   • 2-hour plasma glucose level of ≥200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test. The test should be performed using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water; or
   • HbA1c concentration of ≥6.5% (48 mmol/mol);

3. Systolic blood pressure

   -≥140 mmHg on 0 medication;

   • 130-180 mmHg on 1 medication;
   • 130-170 mmHg on up to 2 medications;
   • 130-160 mmHg on up to 3 medications; or
   • 130-150 mmHg on up to 4 medications;

4. Increased risk of cardiovascular disease (one or more of the following):

   • Previous history of clinical CVD (≥ 3 months)
   • Subclinical CVD within 3 years
   • 2 or more CVD risk factors
   • Estimated glomerular filtration rate (eGFR) 30-59 ml/min/1.73 m2

Exclusion Criteria:

1. History consistent with type 1 diabetes
2. Known secondary cause of hypertension
3. One minute standing systolic BP <110 mmHg
4. Arm circumference too large to allow accurate blood pressure measurement with available devices
5. Cardiovascular event or procedure or hospitalization for unstable angina within the past 3 months
6. Symptomatic heart failure within the past 6 months or left ventricular ejection fraction (by any method) <35% within the past 6 months
7. ALT or AST levels more than twice the upper limit of the normal range or active liver diseases
8. Dialysis, kidney transplantation, eGFR <30 ml/min/1.73 m2, or serum creatinine >2.0 mg/dl
9. Proteinuria
10. Previous diagnosis of polycystic kidney disease or glomerulonephritis
11. A medical condition likely to limit survival to less than 5 years
12. Any factors judged by the clinic team to be likely to limit adherence to interventions
13. Failure to obtain informed consent from participant
14. Currently participating in another intervention study
15. Currently living with another BPROAD participant
16. Pregnancy, currently trying to become pregnant, or of child-bearing potential and not using birth control

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intensive BP treatment arm; Participants in the intensive BP treatment arm will be treated to a systolic BP target of <120 mmHg.	Other: Treatment strategy regarding different systolic BP goals; The trial will test a treatment strategy question regarding different systolic BP goals and not test specific medications. Therefore, the BP treatment protocol is flexible in terms of the choice and doses of anti-hypertensive medications as long as systolic BP levels are within targets (<120 mmHg in the intensive arm and <140 mmHg in the standard arm).
Other: Standard BP treatment arm; Participants in the standard BP treatment arm will be treated to a systolic BP target of <140 mmHg.	Other: Treatment strategy regarding different systolic BP goals; The trial will test a treatment strategy question regarding different systolic BP goals and not test specific medications. Therefore, the BP treatment protocol is flexible in terms of the choice and doses of anti-hypertensive medications as long as systolic BP levels are within targets (<120 mmHg in the intensive arm and <140 mmHg in the standard arm).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Major cardiovascular events	Time to the first occurrence of any of the following: non-fatal stroke, non-fatal myocardial infarction, hospitalized or treated heart failure, or cardiovascular deaths	5 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
A composite of the primary outcome and all-cause mortality	Time to the first occurrence of any of the following: non-fatal stroke, non-fatal MI, hospitalized or treated heart failure, or death	5 years
Total stroke	Fatal and non-fatal stroke	5 years
Heart failure	Hospitalized or treated heart failure, or heart failure death	5 years
Cardiovascular death	Deaths due to cardiovascular causes	5 years
Total mortality	Deaths due to any causes	5 years
Health related quality of life	Evaluated with HQoL scales such as Short Form 12 Health Survey Questionnaire	5 years
Kidney outcomes	Progression of CKD, development of CKD, and incident albuminuria	5 years
Macrovascular outcome	Time to the first occurrence of any of the following: non-fatal stroke, non-fatal MI, hospitalized or treated heart failure, cardiovascular deaths, hospitalized unstable angina, or any cardiovascular revascularization procedures	5 years
Major coronary artery diseases	Time to the first occurrence of any of the following: non-fatal MI, hospitalized unstable angina, revascularization of coronary arteries, or deaths due to coronary artery diseases	5 years
Total MI	Fatal and non-fatal MI	5 years
Ischemic stroke	Fatal and non-fatal ischemic stroke	5 years
Hemorrhagic stoke	Fatal and non-fatal hemorrhagic stoke	5 years
Cognitive function	Time to the first occurrence of any of the following: all-cause dementia or mild cognitive impairment (MCI); all-cause dementia; MCI; changes in global cognitive function and in five specific cognitive domains	5 years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Retinopathy		5 years
All cardiovascular revascularization procedures		5 years
Transient ischemic attack (TIA)		5 years
Left ventricular hypertrophy (LVH)		5 years
Atrial fibrillation or flutter		5 years
All cancers	Time to the first occurrence of any types of cancer	5 years
Cost-effectiveness	The incremental cost per quality adjusted life year (QALY) gained. QALYs will be measured by the EuroQol-5 Dimensions (EQ-5D) questionnaire.	5 years
Hospitalized unstable angina		5 years

Collaborators and Investigators

• Sponsor: Shanghai Jiao Tong University School of Medicine
• Investigators: Principal Investigator: Guang Ning, MD, PhD, Shanghai Jiao Tong University School of Medicine

Publications and helpful links

General Publications

• Saiz LC, Gorricho J, Garjon J, Celaya MC, Erviti J, Leache L. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev. 2020 Sep 9;9(9):CD010315. doi: 10.1002/14651858.CD010315.pub4.
• Saiz LC, Gorricho J, Garjon J, Celaya MC, Erviti J, Leache L. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev. 2022 Nov 18;11(11):CD010315. doi: 10.1002/14651858.CD010315.pub5.

Study record dates

Study Major Dates

• Study Start (Actual): February 24, 2019
• Primary Completion (Actual): May 31, 2024
• Study Completion (Actual): September 15, 2024

Study Registration Dates

• First Submitted: December 16, 2018
• First Submitted That Met QC Criteria: January 15, 2019
• First Posted (Actual): January 17, 2019

Study Record Updates

• Last Update Posted (Actual): October 23, 2024
• Last Update Submitted That Met QC Criteria: October 21, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Endocrine System Diseases; Metabolic Diseases; Glucose Metabolism Disorders; Diabetes Mellitus
• Other Study ID Numbers: Ruijin-2018-138-2

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No