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Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP)

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ClinicalTrials.gov Identifier: NCT03015311
Recruitment Status : Active, not recruiting
First Posted : January 10, 2017
Last Update Posted : March 19, 2018
Sponsor:
Information provided by (Responsible Party):
Jun Cai, Chinese Academy of Medical Sciences, Fuwai Hospital

Brief Summary:
The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) is a 2-arm, multi-center, prospective, randomized, open-labeled, blinded-endpoint trial. The purpose of this trial is to test whether a treatment program aimed at reducing systolic blood pressure (SBP) to a lower goal (<130 mmHg, intensive treatment) than currently recommended (<150 mmHg, standard treatment) will reduce CVD risk among persons between 60-80 years of old. Furthermore, this trial will also examine the effect of blood pressure APP management strategy via WeChat network on medication compliance, blood pressure control and CVD benefits.

Condition or disease Intervention/treatment Phase
Primary Hypertension Drug: Intensive BP control Drug: Standard BP control Not Applicable

Detailed Description:

Hypertension is highly prevalent in the adult population in China, and its burden is rapidly increasing among persons older than 60 years of age. Elevated blood pressure (BP) is an important public health concern which contributes to several adverse health outcomes, especially coronary heart disease, stroke, heart failure, chronic kidney disease, and decline in cognitive function. Clinical trials have shown that a lower systolic blood pressure goal will lead to greater reduction in cardiovascular disease (CVD) incidence, but the effect of intensive treatment of systolic blood pressure below 120 mm Hg in reducing of CVD risk has long been debated. In particularly, among the elderly hypertensive patients aged 60 years or older, the most appropriate targets for blood pressure lowering to reduce cardiovascular events still remain uncertain.

The STEP trial will randomize about 8000 participants aged between 60 and 80 years with SBP≥140 mm Hg and <190 mm Hg, and without a history of atherothrombotic or hemorrhagic stroke. Target SBP goals are 110-130 vs 130-150 mm Hg, respectively. The purpose of the STEP trial is to test whether a treatment program aimed at reducing systolic blood pressure (SBP) to a lower goal (<130 mmHg, intensive treatment) than currently recommended (<150 mmHg, standard treatment) will reduce CVD risk among hypertensive patients between 60-80 years. Participants will be recruited at approximately 40 clinic centers in China within approximately a 1-year period, and will be followed for 4 years. Furthermore, this trial will also examine the effect of blood pressure APP management strategy via WeChat network on medication compliance, blood pressure control and CVD benefits.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 8000 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Strategy of Systolic Blood Pressure Intervention in the Elderly Hypertensive Patients: A Prospective Randomized Open-Label Blinded-Endpoint Trial
Study Start Date : December 2016
Estimated Primary Completion Date : December 2021
Estimated Study Completion Date : December 2021

Arm Intervention/treatment
Experimental: Intensive BP control
SBP within 110 - <130 mm Hg. Participants randomized into the Intensive BP control arm will have a goal of SBP 110 - <130 mm Hg.
Drug: Intensive BP control
For all participants, Olmesartan Medoxomil tablets or Amlodipine Besylate tablets will be used as an initial therapy. Other drugs, including hydrochlorothiazide and β-blockers, are allowed, in order to achieve the SBP target. If the target BP level is not achieved during the Follow-up periods, adjustment of drug type and dosage will be carried out according to procedures defined in the protocol.
Other Name: Lower target for reducing SBP
Active Comparator: Standard BP control
SBP within 130 - <150 mm Hg. Participants randomized into the Intensive BP control arm will have a goal of SBP 130 - <150 mm Hg.
Drug: Standard BP control
For all participants, Olmesartan Medoxomil tablets or Amlodipine Besylate tablets will be used as an initial therapy. Other drugs, including hydrochlorothiazide and β-blockers, are allowed, in order to achieve the SBP target. If the target BP level is not achieved during the Follow-up periods, adjustment of drug type and dosage will be carried out according to procedures defined in the protocol.
Other Name: Standard target for reducing SBP



Primary Outcome Measures :
  1. A composite of major CVD events [ Time Frame: 4 years ]
    A composite end-point comprised of myocardial infarction (MI), first occurrence of symptomatic stroke ( ischemic or hemorrhagic, fatal or nonfatal), hospitalization for unstable angina or acute decompensated heart failure, coronary revascularization (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG]), and death from cardiovascular causes.


Secondary Outcome Measures :
  1. Major coronary events [ Time Frame: 4 years ]
    Major coronary events comprised of myocardial infarction (MI), hospitalization for unstable angina or acute decompensated heart failure, coronary revascularization (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG]), and death from cardiovascular causes.

  2. First occurrence of symptomatic stroke ( ischemic or hemorrhagic, fatal or nonfatal) [ Time Frame: 4 years ]
  3. All-cause death [ Time Frame: 4 years ]
  4. Cardiovascular death [ Time Frame: 4 years ]
  5. myocardial infarction [ Time Frame: 4 years ]
  6. Hospitalization for unstable angina [ Time Frame: 4 years ]
  7. Hospitalization for acute decompensated heart failure [ Time Frame: 4 years ]
  8. coronary revascularization (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG]) [ Time Frame: 4 years ]
  9. First occurrence of diabetes mellitus [ Time Frame: 4 years ]
  10. Decline in cognitive function [ Time Frame: 4 years ]
    Decline in cognitive function includes sensory disturbance, memory disorders and thinking disorders, which is assessed by mini-mental state examination (MMSE)

  11. Decline in renal function or development of end stage renal disease (ESRD) [ Time Frame: 4 years ]
    Decline in renal function is assessed by any of the following: (1) For patients with chronic kidney disease (eGFR <60 ml per minute per 1.73 m2) at baseline, the renal outcome was a composite of a decrease in the eGFR of 50% or more (confirmed by a subsequent laboratory test) or the development of ESRD requiring long-term dialysis or kidney transplantation; or (2) For participants without chronic kidney disease at baseline, the renal outcome was defined by a decrease in the eGFR of 30% or more to a value of less than 60 ml per minute per 1.73 m2.

  12. Major artery function changes [ Time Frame: 4 years ]

    Major artery function changes are assessed by a composite of decrease in the ankle brachial index [ABI], brachial-ankle pulse wave velocity(baPWV), or brachial artery flow-mediated dilation [FMD].

    ABI and baPWV,well-established non-invasive techniques for evaluating obstruction and stiffness of peripheral artery respectively, are considered for the purposes of cardiovascular risk assessment. ABI is the ratio of the average systolic blood pressure measured in brachial/ankle, and an ABI between and including 0.9 and 1.2 is considered normal, while a lesser than 0.9 indicates arterial disease. The unit measure of baPWV value is cm per second.

    FMD serves as an index of nitric oxide (NO)-mediated endothelium-dependent vasodilator function in humans and is regarded as a surrogate marker of cardiovascular disease.




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Ages Eligible for Study:   60 Years to 80 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Systolic BP between 140-190 mm Hg in the three screening visits or currently under anti-hypertension treatment;
  2. An age of 60 - 80 years old;
  3. Signed the written informed consent.

Exclusion Criteria:

  1. Systolic BP≥190 mm Hg, or diastolic BP <60 mm Hg;
  2. Known secondary cause of hypertension;
  3. History of large atherosclerotic cerebral infarction or hemorrhagic stroke (not lacunar infarction and transient ischemic attack [TIA]);
  4. Hospitalization for myocardial infarction or unstable angina within the previous 6 months;
  5. Coronary revascularization (PCI or CABG) within the previous 12 months;
  6. Planned to perform coronary revascularization (PCI or CABG) in the future 12 months;
  7. History of sustained atrial fibrillation or Ventricular arrhythmias at entry influencing the measurement of electronic blood pressure;
  8. NYHA class III-IV heart failure at entry or hospitalization for exacerbation of chronic heart failure within the previous 6 months;
  9. Severe valvular disease or valvular disease likely to require surgery or percutaneous valve replacement during the trial;
  10. Dilated or hypertrophic cardiomyopathy, rheumatic heart disease, or congenital heart disease;
  11. Uncontrolled diabetes (serum fasting glucose ≥200 mg/dl [11.1 mmol/L], HbA1>8%);
  12. Lab tests indicating abnormal liver or kidney function (ALT more than 3 times the upper limit of normal value, or end stage renal disease (ESRD) on dialysis, or estimated glomerular filtration rate (eGFR) <30 mL/min, or serum creatine >2.5 mg/dl [>221 umol/L];
  13. Severe somatic disease such as cancer;
  14. Severe cognitive impairment or mental disorders;
  15. Participating in other clinical trials.

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): NCT03015311


  Show 42 Study Locations
Sponsors and Collaborators
Chinese Academy of Medical Sciences, Fuwai Hospital
Investigators
Study Director: Jun Cai, MD Chinese Academy of Medical Sciences, Fuwai Hospital

Publications:

Responsible Party: Jun Cai, Director, Hypertension Center, Chinese Academy of Medical Sciences, Fuwai Hospital
ClinicalTrials.gov Identifier: NCT03015311     History of Changes
Other Study ID Numbers: 2016CXGC07
2016-I2M-1-006 ( Other Grant/Funding Number: CAMS Innovation Fund for Medical Sciences )
First Posted: January 10, 2017    Key Record Dates
Last Update Posted: March 19, 2018
Last Verified: March 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Keywords provided by Jun Cai, Chinese Academy of Medical Sciences, Fuwai Hospital:
Blood pressure control

Additional relevant MeSH terms:
Hydrochlorothiazide
Olmesartan Medoxomil
Antihypertensive Agents
Diuretics
Natriuretic Agents
Physiological Effects of Drugs
Sodium Chloride Symporter Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Angiotensin II Type 1 Receptor Blockers
Angiotensin Receptor Antagonists