- ICH GCP
- Amerikanska kliniska prövningsregistret
- Klinisk prövning NCT04649463
Ambulatory Blood Pressure Monitoring in Patients With Coronary Artery Disease (PCI-BP)
Ambulatory Blood Pressure Monitoring Optimizes Blood Pressure Control in Patients With Coronary Artery Disease-a Randomized Controlled Trial
Studieöversikt
Status
Betingelser
Intervention / Behandling
Detaljerad beskrivning
Study design and patient population We included 225 patients scheduled for follow up after an acute or elective percutaneous coronary intervention (PCI) at the Department of Cardiology at the Karolinska University Hospital 2009-2015. Exclusion criteria were age <18 or >90 years. Information on medical history, date and indication for PCI were collected from the medical records, by the study physician (OH).
All patients were subject to ABPM at baseline (3-6 weeks after PCI) and follow up (11-18 weeks after PCI. At the time of the first ABPM the patients also completed a questionnaire about smoking habits and current antihypertensive drug treatment. Weight (kg) and height (cm) was measured. At the clinical follow up visit one to two weeks later they were assessed by a cardiologist not involved in the study. At this visit ABPM results were either used or not according to randomization in the decision making for adjustments in antihypertensive medication. The cardiologists were provided with reference values for ABPM according to guidelines.26,27 For those with concealed ABPM-results the OBP was used for decision making regarding changes in antihypertensive treatment. Finally, results regarding BP control were assessed at the second ABPM 8-12 weeks following the first measurement.
Office Blood pressure measurement OBP was recorded in both arms by a biomedical scientist or a specialized nurse (study staff) using a mercury sphygmomanometer with the subject in the supine position after 5 min of rest. The mean of two consecutive readings was calculated. If there was a difference in systolic or diastolic BP (SBP, DBP) between the arms of >10 mmHg, the arm with the highest reading was used when defining OBP, otherwise the non-dominant arm was used. The same arm was used at the follow up where either the physician or a nurse measured OBP after having been given instructions for standardized BP measurement as described above.
Ambulatory BP Ambulatory BP values were obtained using a noninvasive oscillometric system (Spacelabs 90217, Spacelabs Healthcare, Hertford, UK). The device was fitted to the patient by one of the study staff. Patients were instructed not to restrict their daily activities during the monitoring periods. Before the start of the monitoring period, the automatic readings were cross-checked against manually measured BP by auscultation. The device was fitted to the nondominant arm, unless a difference of >10 mmHg in SBP between the arms was recorded, in which case the arm with the highest pressure was used. BP and heart rate were recorded automatically every 20 minutes' daytime and every hour at night for a 24-h period. The BP data was auto-edited by the Spacelabs program, which excluded presumably erroneous data. No manual editing of data was carried out in order not to induce bias. Means were calculated for the whole 24-h period, and for day (07.00-21.00) and night (24.00-06.00) periods separately.
Antihypertensive drug treatment The agents according to guidelines26 27 classified as BP lowering were thiazide- and potassium saving diuretics, beta-blockers, calcium antagonists, ACE inhibitors, angiotensin II receptor blockers and others (doxazocin only one used). At the follow up antihypertensive treatment changes were reported by the physician in the study protocol. The patients' current antihypertensive treatment was also documented prior to the 2nd ABPM by the study staff. All antihypertensive treatment was further recorded as a percentage of recommended maximal daily doses, to allow for calculation of treatment change. The latter was calculated as the difference in antihypertensive treatment between prior to the physician follow up and ongoing medication at the 2nd ABPM.
Statistical analysis Mean and standard deviation (SD) were used for numerical data whereas median and range was used for the number of days until follow-up visit and the number of BP-lowering agents. Chi-square-tests or Fishers exact test were used to compare ratios between groups where the variables were nominal. Independent t-tests were used to compare continuous variables between groups, since the variables investigated were normally distributed. In order to study whether the intervention optimized BP across the distribution of baseline ABP, a multivariate analysis was performed and the interactions between study groups on the association between baseline ABP and change in ABP as well as change in antihypertensive therapy was calculated. Separate analysis was performed in the diabetic subgroup. A p-value <0.05 were used to define statistical significance. Statistical analysis was done in the StatSoft program STATISTICA®.
Ethical considerations Ethical approval was applied for and approved by the Stockholm Regional Ethical Review Board, reference number 2008/1017-31. All subjects gave informed consent.
Studietyp
Inskrivning (Faktisk)
Fas
- Inte tillämpbar
Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria:
* Patient scheduled for follow up after an acute or elective percutaneous coronary intervention (PCI) for coronary atherosclerosis at the Department of Cardiology at the Karolinska University Hospital
Exclusion Criteria:
- Age below 18 years
- Age above 90 years
- Severe cognitive dysfunction
- Severe somatic disease constituting an obstacle for completing follow up
- Current atrial fibrillation
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Förebyggande
- Tilldelning: Randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
---|---|
Aktiv komparator: Open ABPM results
ABPM results were used in the decision making for adjustments in antihypertensive medication at follow up visit.
|
ABPM results were used in the decision making for adjustments in antihypertensive medication at follow up visit.
|
Sham Comparator: Concealed ABPM results
ABPM results were not used in the decision making for adjustments in antihypertensive medication at follow up visit.
|
ABPM results were used in the decision making for adjustments in antihypertensive medication at follow up visit.
|
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
The primary efficacy variable was the difference between groups in change of mean night time blood pressure between the first and second ABPM.
Tidsram: Change in mean nighttime ABPM between first to second ABPM ( First 3-6 weeks after PCI and second 11-18 weeks after PCI)
|
Change in mean systolic blood pressure as assessed by ABPM between 24.00 to 6.00 between groups (open or concealed 24-hour ABPM).
|
Change in mean nighttime ABPM between first to second ABPM ( First 3-6 weeks after PCI and second 11-18 weeks after PCI)
|
Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Frequency of patients with 24-hour hypertensionl at 11-18 weeks after PCI
Tidsram: 11-18 weeks after PCI
|
24-hour hypertension is defined as average 24-h SBP>130 mm Hg or 24-h DBP >80 mm Hg
|
11-18 weeks after PCI
|
Samarbetspartners och utredare
Sponsor
Samarbetspartners
Utredare
- Huvudutredare: Jan B Östergren, MD. PhD, Karolinska Institutet
Studieavstämningsdatum
Studera stora datum
Studiestart (Faktisk)
Primärt slutförande (Faktisk)
Avslutad studie (Faktisk)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Faktisk)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- 2011-38425
Plan för individuella deltagardata (IPD)
Planerar du att dela individuella deltagardata (IPD)?
IPD-planbeskrivning
Tidsram för IPD-delning
Kriterier för IPD Sharing Access
IPD-delning som stöder informationstyp
- Studieprotokoll
- Statistisk analysplan (SAP)
- Informerat samtycke (ICF)
- Klinisk studierapport (CSR)
- Analytisk kod
Läkemedels- och apparatinformation, studiedokument
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