- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05292469
Comprehensive Approach to Hypertension Management in Nepal
July 4, 2023 updated by: Norwegian University of Science and Technology
A Cluster Randomized Trial to Evaluate Comprehensive Approach to Hypertension Management in Nepal
Hypertension is a global risk factor for cardiovascular diseases.
Approximately 80% hypertension burden is in low-and-middle income countries.
Hypertension can be managed with antihypertensive medication and following effective lifestyle interventions, however the control rate of hypertension among those on treatment is dismal.
In Nepal, a quarter of adult population have hypertension of whom, 44% are unaware of their status, 33% are on treatment, and, only 12% are controlled.
A comprehensive intervention strategy for hypertension management has shown promising results in high income countries.
Therefore, it is of interest to understand its effectiveness, appropriateness and feasibility in the low income settings such as Nepal.
The objective of the trial is to assess the impact on net change in mean systolic blood pressure measured between 7 to 8 months follow-up of a comprehensive intervention which provides personalized counselling on lifestyle modification and medication adherence together with support for regular monitoring of blood pressure at home, compared with a control arm where hypertensive patients have access to routine care only.
The investigators are proposing a cluster randomized controlled trial conducted in government health facilities from Budhanilakantha, an urban municipality in the Bagmati Province of Nepal.
Trial arms: 1) control (routine hypertension care); 2) Comprehensive approach to hypertension management that includes blood pressure (BP) audit and feedback by physician (nurse and doctor), and patient support to monitor BP, and home based patient care by community health workers to encourage self-monitoring of BP followed by tailored educational counselling on behavioral and lifestyle change.
Eligible participants providing consent will be enrolled into the trial by a research assistant who will conduct interviews.
Those from the intervention arm will receive the home visits for 6 months.
Participants from both arms will provide follow up data in 7 to 8 months.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Estimated)
1250
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 Contact
- Name: Abhijit Sen, prof
- Phone Number: +47 40106033
- Email: abhijit.sen@ntnu.no
Study Contact Backup
- Name: Sanju Bhattarai
- Phone Number: +977 9851055424
- Email: sanjuwagle@gmail.com
Study Locations
-
-
-
Kathmandu, Nepal
- Recruiting
- Institute for Implementation Sciences and Health
-
Contact:
- Sanju Bhattarai
- Phone Number: +977 9851055424
- Email: sanjuwagle@gmail.com
-
-
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 and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Hypertension patients (systolic blood pressure 140 mmHg or more and/or diastolic blood pressure 90 mmHg or more on at least two separate visits, or use of antihypertensive medication)
- Living in the area served by the participating health facilities
Exclusion Criteria:
- Pregnancy
- Not able or willing to give informed consent,
- Critically ill from depilating conditions such as dialysis, cancer, palliative care
- Not likely to continue living in the area served by the health facility during trial follow up period (8 months)
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: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control arm
Routine hypertension care
|
|
Experimental: Intervention arm
Comprehensive approach to hypertension management that includes BP audit and feedback by physician (nurse and doctor), and patient support to monitor BP, and home based patient care by community health workers to encourage self-monitoring of BP followed by tailored educational counselling on behavioral and lifestyle change in addition to routine care.
|
Trained health workers will review blood pressure (BP) logs and provide treatment.
The patients will receive a BP lowering informational package, BP monitoring device and log book and pill-box and medication table.
The participants will receive monthly home visits (6 visits) to discuss hypertension and ways to manage it.
They will be encouraged to identify problems and developing an action plan to solve them.
The participants will be encouraged to set behavioral goals.
The follow up visits will review the progress made in implementing action plan and goals set and updating them.
Review BP logs and facilitate tailored discussion on topics based on problems faced by participants on barriers to medication adherence, physical activity, weight management or diet.
The family members will be involved and be accountable in supporting the patients in achieving the action plans.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mean systolic blood pressure (BP) (mmHg)
Time Frame: Measured at baseline and follow up between 7 to 8 months after baseline
|
Net change in mean systolic BP from baseline to follow up
|
Measured at baseline and follow up between 7 to 8 months after baseline
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mean diastolic BP (mmHg)
Time Frame: Measured at baseline and follow up between 7 to 8 months after baseline
|
Net change in mean diastolic BP from baseline to follow up
|
Measured at baseline and follow up between 7 to 8 months after baseline
|
Proportion controlling BP (<140/90 mmHg)
Time Frame: Measured at baseline and follow up between 7 to 8 months after baseline
|
Proportion of participants controlling BP (<140/90 mmHg) from baseline to follow up
|
Measured at baseline and follow up between 7 to 8 months after baseline
|
Waist Circumference (cm)
Time Frame: Measured at baseline and follow up between 7 to 8 months after baseline
|
The mean difference in waist circumference measured at baseline and follow up
|
Measured at baseline and follow up between 7 to 8 months after baseline
|
Body weight (Kg)
Time Frame: Measured at baseline and follow up between 7 to 8 months after baseline
|
The mean difference in weight measured at baseline and follow up
|
Measured at baseline and follow up between 7 to 8 months after baseline
|
Diet low in cholesterol, high in fruits and vegetables
Time Frame: Reported at baseline and follow up between 7 to 8 months after baseline
|
The proportion consuming diet low in cholesterol, high in fruits and vegetables in the last 24 hours self reported at baseline and follow up
|
Reported at baseline and follow up between 7 to 8 months after baseline
|
Daily salt intake (<1 teaspoon per day)
Time Frame: Reported at baseline and follow up between 7 to 8 months after baseline
|
The proportion consuming less than 1 teaspoon of salt per day self reported at baseline and follow up
|
Reported at baseline and follow up between 7 to 8 months after baseline
|
Medication adherence
Time Frame: Self reported at baseline and follow up between 7 to 8 months after baseline
|
The proportion adhering to prescribed medication in the past two weeks measured at baseline and follow up
|
Self reported at baseline and follow up between 7 to 8 months after baseline
|
Physical activity
Time Frame: Self reported at baseline and follow up between 7 to 8 months after baseline
|
The proportion engaged in moderate physical activity (2.5 hours per week) measured at baseline and follow up
|
Self reported at baseline and follow up between 7 to 8 months after baseline
|
Hypertension Knowledge Score
Time Frame: Self reported at baseline and follow up between 7 to 8 months after baseline
|
All together 21 hypertension knowledge statement with 12 true false responses and others with multiple responses to create a aggregate score on hypertension Knowledge
|
Self reported at baseline and follow up between 7 to 8 months after baseline
|
Perceived Social Support Scale
Time Frame: Self reported at baseline and follow up between 7 to 8 months after baseline
|
Twelve statements on perceived social support with 7 point Likert scale will be used at baseline and endline
|
Self reported at baseline and follow up between 7 to 8 months after baseline
|
Maintaining BP logs
Time Frame: Self reported at follow up between 7 to 8 months after baseline
|
Proportion of trial participants maintaining self BP measurement logs asked during follow up
|
Self reported at follow up between 7 to 8 months after baseline
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Study Director: Solveig Kirsti Grudt, Norwegian University of Science and Technology
- Principal Investigator: Abhijit Sen, prof, Norwegian University of Science and Technology
- Principal Investigator: Archana Shrestha, Institute for Implementation Sciences and Health, Nepal
- Principal Investigator: Sanju Bhattarai, Institute for Implementation Science and Health
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 (Actual)
May 2, 2022
Primary Completion (Estimated)
September 1, 2023
Study Completion (Estimated)
September 1, 2023
Study Registration Dates
First Submitted
March 9, 2022
First Submitted That Met QC Criteria
March 22, 2022
First Posted (Actual)
March 23, 2022
Study Record Updates
Last Update Posted (Actual)
July 6, 2023
Last Update Submitted That Met QC Criteria
July 4, 2023
Last Verified
July 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 399476
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
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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