- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05529147
The Effects of Medication Induced Blood Pressure Reduction on Cerebral Hemodynamics in Hypertensive Frail Elderly (BLUEBERRY)
Rationale: Systolic hypertension represents the leading risk for burden of disease among older adults (age >70 years), with an increasing prevalence due to the increase in lifespan. Antihypertensive drug treatment (AHT) is beneficial in fit (non-frail) older adults, with substantial (≈40 %) risk reductions for cardiovascular events and mortality. Scarce evidence exists on the risks of adverse effects related to AHT. It has been suggested in medical literature that AHT in frail elderly might cause cerebral hypoperfusion and/or orthostatic hypotension. Therefore, current guidelines advise clinicians to be more cautious regarding treatment targets in this population. However, the evidence for these adverse effects is limited to observational and cross-sectional data and opinion pieces. In contrast to the suggestion of potential adverse effects of AHT in elderly, recent experimental data and secondary analyses of clinical trials do not provide support for this statement. However, evidence in frail older patients remains scarce. Studies that directly examine the safety of AHT with regard to cerebral hemodynamics and orthostatic tolerance in frail elderly are needed to inform potential changes in current treatment guidelines and prevent undertreatment of hypertension in frail older patients.
Objective: To examine the impact of medication induced systolic BP (SBP) reductions ≥10 mmHg, while reaching a treatment target of ≤140 mmHg, on cerebral blood flow (CBF) in frail elderly with untreated or uncontrolled systolic hypertension at baseline. We hypothesise that these blood pressure lowering targets (which are consistent with clinical guidelines for non-frail older patients) are not accompanied by detrimental reductions in CBF (i.e. >10% from baseline).
Study design: An explorative observational study will be performed to examine the effects of medication induced SBP reductions ≥10 mmHg to office SBP ≤140 mmHg on CBF in frail elderly with untreated or uncontrolled hypertension. Participants will be treated as in usual patient care for older adults with hypertension. Participants will undergo one baseline assessment before exposure to (additional) AHT, followed by in duplo follow-up assessments 6-10 weeks after the start of AHT. The in duplo follow-up evaluations will be performed on separate days within 2 weeks while continuing treatment.
Study population: Twelve frail (Clinical Frailty Scale 4-7) elderly (age ≥70 years) with untreated or uncontrolled systolic hypertension (office SBP ≥150 mmHg) that will be subjected to (additional) AHT as part of regular care.
Main study parameters/endpoints: The change in resting CBF from baseline to follow-up (i.e. the average of the in duplo follow-up assessments). Secondary outcomes relate to cerebrovascular autoregulation (CA) and orthostatic tolerance.
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Subjects will be subjected to AHT, essentially identical to what is considered 'guideline care', while their wellbeing will be monitored closely. Since all study procedures and used measurement techniques are non-invasive, the nature and extent of burden and risks associated with participation and measurements are negligible.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Ralf W Weijs, MSc
- Phone Number: +31653421561
- Email: ralf.weijs@radboudumc.nl
Study Contact Backup
- Name: Jurgen A Claassen, MD, PhD
- Phone Number: +31243697059
- Email: jurgen.claassen@radboudumc.nl
Study Locations
-
-
Gelderland
-
Nijmegen, Gelderland, Netherlands, 6525 GA
- Recruiting
- Radboudumc
-
Contact:
- Ralf W Weijs, MSc
- Phone Number: +31243610152
- Email: ralf.weijs@radboudumc.nl
-
Contact:
- Jurgen A Claassen, MD, PhD
- Email: jurgen.claassen@radboudumc.nl
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Age ≥70 years.
- Clinical Frailty Scale ≥4 and ≤7.
Diagnosis of:
- Untreated systolic hypertension, i.e. unattended office SBP ≥150 mmHg without AHT, or;
- Uncontrolled systolic hypertension, i.e. unattended office SBP ≥150 mmHg despite AHT.
Will be starting (untreated) or adding (uncontrolled) AHT in the near future for (further) reducing SBP by ≥10 mmHg while reaching a treatment target of unattended office SBP
≤140 mmHg, while keeping unattended office diastolic blood pressure ≥70 mmHg, with the indication of primary or secondary prevention of vascular events, judged by the treating physician (geriatrician or primary care physician)
- Able to understand and perform study related procedures.
Exclusion Criteria:
- Unable to provide signed and dated informed consent form.
- Mentally incompetent subjects (e.g. due to dementia) as assessed by a physician.
- Currently enrolled in another interventional study targeting either BP and/or CBF.
- Cardiovascular event within the past 3 months.
- Estimated glomerular filtration rate (eGFR) <40 ml/min.
- Known secondary cause of hypertension that causes safety concerns.
Study Plan
How is the study designed?
Design Details
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in MCAv across follow-up
Time Frame: 6-8 weeks
|
The primary study parameter is the relative change in CBF from baseline to follow-up (i.e. the average of the in duplo follow-up assessments), measured as the mean bilateral CBF velocity in the MCA (in cm/s).
|
6-8 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in cerebral autoregulation and orthostatic tolerance
Time Frame: 6-8 weeks
|
The relative and absolute changes in measures of CA (i.e.
dCA and BRS) and OT from baseline to follow-up.
Regarding OT, it will also be evaluated whether the incidence of orthostatic hypotension differs between baseline and follow-up assessments.
|
6-8 weeks
|
Collaborators and Investigators
Investigators
- Principal Investigator: Jurgen A Claassen, MD, PhD, Radboud University Medical Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- NL80929.091.22
- 2022-001283-10 (EudraCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on Hypertension
-
National Taiwan University Hospital Hsin-Chu BranchRecruitingHypertension,Essential | Hypertension, MaskedTaiwan
-
University of Alabama at BirminghamTroy UniversityCompletedHypertension | Hypertension, Resistant to Conventional Therapy | Uncontrolled Hypertension | Hypertension, White CoatUnited States
-
BayerCompletedPrimary HypertensionChina
-
Addpharma Inc.Completed
-
Columbia UniversityAgency for Healthcare Research and Quality (AHRQ)Active, not recruitingWhite Coat Hypertension | Hypertension,EssentialUnited States
-
Universidade Federal de Santa MariaCompletedHealthy Volunteers | Hypertension, EssentialBrazil
-
Sheffield Teaching Hospitals NHS Foundation TrustUniversity of SheffieldCompletedIdiopathic Pulmonary Arterial Hypertension | Chronic Thromboembolic Pulmonary HypertensionUnited Kingdom
-
Sulaiman AlRajhi CollegesUnknownHypertension, Essential | β-hydroxybutyrate
-
China Academy of Chinese Medical SciencesGuang'anmen Hospital of China Academy of Chinese Medical SciencesCompletedHypertension, Resistant to Conventional Therapy | Primary HypertensionChina
Clinical Trials on Antihypertensive Agents
-
University of Alabama at BirminghamNational Heart, Lung, and Blood Institute (NHLBI)RecruitingPreeclampsia | Hypertensive Disorder of Pregnancy | Gestational HypertensionUnited States
-
University of PittsburghNational Institute on Aging (NIA)CompletedHypertension | Sleep Disturbance | NocturiaUnited States
-
University of AlbertaAlberta Health servicesEnrolling by invitation
-
Asan Medical CenterBoryung Pharmaceutical Co., LtdCompleted
-
Annina VischerNot yet recruitingHypertension | Blood Pressure, High
-
Chongqing Medical UniversityRecruitingHypertension | Primary AldosteronismChina
-
Center of Personalized Medicine, PirogovaUniversity of Rochester; I.M. Sechenov First Moscow State Medical University; Federal State Budgetary Institution, V. A. Almazov Federal North-West Medical Research Centre, of the Ministry of Health and other collaboratorsRecruitingAdherence to Personalized EBM Antihypertensive Drug Prescriptions for Patients With Hypertension and Comorbidities in Everyday Clinical PracticeRussian Federation
-
Maastricht University Medical CenterWithdrawnEssential Hypertension | Primary Aldosteronism
-
University of MinnesotaCompletedHypertension | Masked Hypertension | Chronic Renal InsufficiencyUnited States
-
University of AlbertaHeart and Stroke Foundation of Canada; Alberta Heritage Foundation for Medical...CompletedIschemic Stroke | Transient Ischemic AttacksCanada