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Trial record 1 of 2 for:    NCT02670031
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REMODEL: Hypertensive Heart Disease

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ClinicalTrials.gov Identifier: NCT02670031
Recruitment Status : Unknown
Verified December 2016 by National Heart Centre Singapore.
Recruitment status was:  Recruiting
First Posted : February 1, 2016
Last Update Posted : December 9, 2016
Sponsor:
Information provided by (Responsible Party):
National Heart Centre Singapore

Brief Summary:
Hypertension and aortic stenosis are the two leading conditions that cause thickening of the heart muscles (left ventricular hypertrophy). Left ventricular hypertrophy is initially adaptive to maintain optimal heart function. Ultimately, heart failure occurs as a result of progressive muscle cell death and scarring (myocardial fibrosis). Dedicated techniques using cardiovascular magnetic resonance imaging (MRI) and novel high-sensitivity cardiac troponin blood assays are potential markers to detect myocardial fibrosis. Although hypertension-related heart disease is very common in Singapore, the significance of myocardial fibrosis is not well understood. In this study, the significance of myocardial fibrosis in 500 patients with hypertension would be investigated. This will be the largest study using state-of-the-art MRI to examine the importance of myocardial fibrosis in hypertensive heart disease.

Condition or disease Intervention/treatment
Left Ventricular Hypertrophy Hypertension Myocardial Fibrosis Other: Cardiovascular Magnetic Resonance Other: Echocardiogram Other: Electrocardiogram Device: Ambulatory Blood Pressure Monitoring

Detailed Description:

According to the National Health Survey in 2010, more than 50% of adults between 60-69 years old in Singapore had hypertension. As the population ages and life expectancy continues to increase, an increasing incidence of hypertensive heart disease would be expected. Similar to aortic stenosis, left ventricular hypertrophy in patients with hypertension was associated with adverse cardiovascular outcome, independent of traditional risk factors including peripheral blood pressure. Unlike aortic stenosis (a condition with fixed obstruction), arterial hypertension is dynamic and with effective medical therapy, left ventricular hypertrophy can regress and outcome will improve. As such, contemporary guidelines recommend more aggressive blood pressure control in patients with hypertension and left ventricular hypertrophy. However, the correlation between arterial pressure and left ventricular mass is weak, particularly in treated individuals. Coupled with the inherent limitations of measuring peripheral blood pressure, it is clear that using arterial pressure to monitor progression or assess treatment response in patients with hypertensive heart disease is not optimal.

Without timely and appropriate therapies, left ventricular hypertrophy will become progressively maladaptive and ultimately the heart fails. Whilst heart failure is more commonly known by the signs and symptoms related to impaired systolic ejection fraction, heart failure with preserved ejection fraction is an increasingly recognized complex entity characterized by signs and symptoms of heart failure in the presence of preserved ejection fraction. To date, therapies that improve outcomes in heart failure with reduced ejection fraction have not shown similar benefits in patients with heart failure and preserved ejection fraction. There is no single explanation for these negative findings, but one potential reason may relate to the heterogeneity of patients recruited into these trials, and thus supporting a more targeted approach to specific phenotypes rather than a standard treatment strategy for all patients.

Therefore, a focus on the transition from compensatory left ventricular hypertrophy to ventricular decompensation is crucial not only in furthering our understanding of the pathophysiology of hypertensive heart disease, but also instrumental in designing future trials. Small studies had reported replacement myocardial fibrosis in patients with hypertension. But these studies were small and unable to establish determinants associated with myocardial fibrosis. Unlike the increasing evidence of myocardial fibrosis in aortic stenosis, the prognosis associated with myocardial fibrosis in patients with hypertension is currently not known. Although there is promising data suggesting regression in myocardial fibrosis with certain antihypertensive therapies, the effects of myocardial fibrosis regression on long-term outcome is not known. As discussed earlier, other than relying on peripheral blood pressure, there are no biomarkers to monitor response of antihypertensive therapy on regression of left ventricular mass and myocardial fibrosis.

Our investigators would establish a paradigm to demonstrate the significance of myocardial fibrosis in hypertensive heart disease; and examine other biomarkers associated with myocardial fibrosis and myocyte death that have high potential of translating into clinical application to monitor treatment response.


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Study Type : Observational
Estimated Enrollment : 500 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Response of the Myocardium to Hypertrophic Conditions in the Adult Population
Study Start Date : January 2016
Estimated Primary Completion Date : January 2018
Estimated Study Completion Date : May 2018

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Heart Diseases

Group/Cohort Intervention/treatment
Newly Diagnosed Hypertension
Patients will undergo the following studying procedures: electrocardiogram, echocardiogram, cardiovascular magnetic resonance imaging and 24-hr ambulatory blood pressure monitoring.
Other: Cardiovascular Magnetic Resonance
For the evaluation of left ventricular volumes, function and mass. This is also for the assessment of myocardial fibrosis based on delayed enhancement imaging technique.

Other: Echocardiogram
For the assessment of diastolic and systolic function as well as valvular and cardiac function. Ventricular-arterial coupling will also be performed.

Other: Electrocardiogram
To examine specific function of the heart.

Device: Ambulatory Blood Pressure Monitoring
A 24-hour test.

Well-Controlled Hypertension
Patients will undergo the following studying procedures: electrocardiogram, echocardiogram, cardiovascular magnetic resonance imaging and 24-hr ambulatory blood pressure monitoring.
Other: Cardiovascular Magnetic Resonance
For the evaluation of left ventricular volumes, function and mass. This is also for the assessment of myocardial fibrosis based on delayed enhancement imaging technique.

Other: Echocardiogram
For the assessment of diastolic and systolic function as well as valvular and cardiac function. Ventricular-arterial coupling will also be performed.

Other: Electrocardiogram
To examine specific function of the heart.

Device: Ambulatory Blood Pressure Monitoring
A 24-hour test.

Resistant Essential Hypertension
Patients will undergo the following studying procedures: electrocardiogram, echocardiogram, cardiovascular magnetic resonance imaging and 24-hr ambulatory blood pressure monitoring.
Other: Cardiovascular Magnetic Resonance
For the evaluation of left ventricular volumes, function and mass. This is also for the assessment of myocardial fibrosis based on delayed enhancement imaging technique.

Other: Echocardiogram
For the assessment of diastolic and systolic function as well as valvular and cardiac function. Ventricular-arterial coupling will also be performed.

Other: Electrocardiogram
To examine specific function of the heart.

Device: Ambulatory Blood Pressure Monitoring
A 24-hour test.




Primary Outcome Measures :
  1. First occurrence of cardiovascular event [ Time Frame: One year ]

Biospecimen Retention:   Samples With DNA
Blood samples will be collected from all participants.


Information from the National Library of Medicine

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Ages Eligible for Study:   21 Years to 99 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Patients will be recruited from primary care clinic and outpatient clinics from the National Heart Centre Singapore. In addition, they will be recruited through posters and advertisements.
Criteria

Inclusion Criteria:

  1. 21 years and over
  2. Physician diagnosed essential hypertension, on at least 1 medication for blood pressure control
  3. Newly diagnosed hypertension: systolic blood pressure 140mmHg or greater (diastolic blood pressure 90mmHg or greater) on at least 2 office visits (Weber 2013) and not started on any anti hypertensive medications at time of ambulatory blood pressure monitoring
  4. Resistant hypertension: persistent systolic blood pressure 140mmHg or greater (diastolic blood pressure 90mmHg or greater) despite on at least 3 anti-hypertensive medications (Jennings 2013; Weber 2013)

Exclusion Criteria:

  1. Known secondary hypertension: renal causes (renal artery stenosis, chronic renal failure); endocrine causes (aldosterone excess, pheochromocytoma, cushing's syndrome, hyperthyroidism); cardiac causes (coarctation of the aorta)
  2. Contraindications to cardiovascular magnetic resonance: implantable devices, cerebral aneurysm clips, cochlear implants, renal impairment (GRF <30ml/min/1.73m2), claustrophobia and women who are pregnant or breast-feeding
  3. Limited life expectancy
  4. On-going unstable medical conditions: hypertensive crisis, acute coronary syndromes or acute heart failure
  5. History of coronary artery disease, ischemic heart disease
  6. History of transient ischemic attacks or cerebrovascular events
  7. History of atrial fibrillation
  8. History of heart failure

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02670031


Contacts
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Contact: Chloe PY Sim (65) 6704 2294 chloe.sim.p.y@nhcs.com.sg

Locations
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Singapore
National Heart Centre Singapore Recruiting
Singapore, Singapore, 169609
Sponsors and Collaborators
National Heart Centre Singapore
Investigators
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Principal Investigator: Calvin WL Chin, MBBS, PhD National Heart Centre Singapore

Publications:

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: National Heart Centre Singapore
ClinicalTrials.gov Identifier: NCT02670031     History of Changes
Other Study ID Numbers: 2015/2603
First Posted: February 1, 2016    Key Record Dates
Last Update Posted: December 9, 2016
Last Verified: December 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by National Heart Centre Singapore:
Hypertensive Heart Disease
Hypertension
Left Ventricular Hypertrophy
Myocardial Fibrosis
Cardiovascular Magnetic Resonance Imaging
Additional relevant MeSH terms:
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Hypertension
Hypertrophy, Left Ventricular
Fibrosis
Hypertrophy
Vascular Diseases
Cardiovascular Diseases
Pathologic Processes
Heart Diseases
Pathological Conditions, Anatomical
Cardiomegaly