Controlling Hypertension After Severe Cerebrovascular Event

NCT ID: NCT02982655

Last Updated: 2019-04-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-31

Study Completion Date

2018-11-30

Brief Summary

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The purpose of this academic lead study is to explore ideal blood pressure targets and optimum individualized anti-hypertension strategies in acute severe stroke.

Detailed Description

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Of high mortality and morbidity, severe stroke is associated with devastating damages in neurologic, respiratory, circulatory and many other systems. The outcomes of patients with severe stroke depend largely on medical strategies on acute stage, especially on blood pressure (BP) management. Unfortunately, so far no ideal BP range has been scientifically determined for patients with acute severe stroke.

The CHASE study aims to provide reliable data on the effects of individualized anti-hypertension strategy in patients with acute severe stroke (target recruitment 250) compared to standard guideline-based management of BP (target recruitment 250). Patients presenting with acute (\<72h) severe stroke (GCS ≦ 12 or NIHSS ≧ 11) and elevated BP (systolic blood pressure ≧150 mmHg or diastolic blood pressure ≧ 100 mmHg) will be randomly assigned to individualized anti-hypertension treatment or guideline-based treatment for 7 days.

Conditions

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Severe Stroke Acute Stroke Hypertension

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Individualized BP lowering

Management policy is to lower the systolic or diastolic BP by 10-15% within 2 hours of randomization and sustained for 7 days. Sites were provided with protocols for different intravenous agents and used whichever routinely available drugs were in their hospital.

Group Type EXPERIMENTAL

Individualized BP lowering

Intervention Type PROCEDURE

Guideline recommended BP lowering

Patients received management of BP based on the standard guidelines at the time, as published by the Chinese Society of Neurology (CSN) in 2014. The attending clinician may consider commencing BP treatment and sustained for 7 days if the systolic BP \> 200 mmHg or diastolic BP \>110 mmHg in patients with ischemic stroke, and systolic BP \> 180 mmHg or diastolic BP \> 110 mmHg in patients with cerebral hemorrhage.

Group Type ACTIVE_COMPARATOR

Individualized BP lowering

Intervention Type PROCEDURE

Interventions

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Individualized BP lowering

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. age ≥ 18 years;
2. the randomly assigned BP-lowering regimen is able to be commenced within 72 h after the onset of stroke (ischemic or hemorrhagic), confirmed by a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain (if the precise timing of the onset of symptoms or signs of the qualifying event is unknown, then the time of onset will be taken as the last time the patient was known to be well);
3. GCS on admission ≤ 12 or NIHSS on admission ≥ 11;
4. there are at least two SBP measurements of ≥ 150 and ≤ 210 mmHg, recorded ≥5 min apart (patients with an initial SBP \< 150 mmHg may be randomized when the SBP fulfils entry criteria on rechecking up to 72 h after the onset of stroke);
5. written informed consent is able to be obtained directly from the patient or an appropriate surrogate, based on local ethics committee recommendations.

Exclusion Criteria

1. patients who have received thrombolytic therapy, embolectomy, or decompressive craniectomy for the current stroke;
2. patients with subarachnoid hemorrhage;
3. known definite contraindication to acute BP lowering (e.g. known severe carotid, vertebral, or cerebral arterial stenosis, Moyamoya disease or Takayasu's arteritis, high grade stenotic valvular heart disease);
4. secondary to a structural abnormality in the brain (e.g. an arteriovenous malformation, intracranial aneurysm, tumor, or trauma);
5. unstable vital signs and requiring the use of vasoactive agents;
6. known existing dementia or prestroke disability (e.g. score 3-5 on the modified Rankin scale);
7. concomitant medical illness that would interfere with the outcome assessments and/or follow-up (advanced cancer; severe pulmonary dysfunction \[forced expiratory volume in 1 s \< 50%\]; severe cardiac dysfunction \[ejection fraction ≤ 50%\]; severe hepatic failure \[Child-Pugh score ≥ 7\]; severe renal failure \[glomerular filtration rate ≤ 30 mL/min or serum creatinine ≥ 4 mg/dL\]);
8. patients who are currently participating in other investigational trials;
9. patients who are considered to have a high likelihood of not adhering to the study treatment or the follow-up regimen.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Tang-Du Hospital

OTHER

Sponsor Role collaborator

Xi'an Central Hospital

OTHER

Sponsor Role collaborator

Shaanxi Provincial People's Hospital

OTHER

Sponsor Role collaborator

Hanzhong Central Hospital

OTHER

Sponsor Role collaborator

Yan'an University Affiliated Hospital

OTHER

Sponsor Role collaborator

Xiangyang Central Hospital

OTHER

Sponsor Role collaborator

Xi'an 141 Hospital

UNKNOWN

Sponsor Role collaborator

Shangluo Central Hospital

OTHER

Sponsor Role collaborator

215 Hospital of Shaanxi NI

OTHER

Sponsor Role collaborator

Yulin No.2 Hospital

OTHER

Sponsor Role collaborator

Yulin No.1 Hospital

UNKNOWN

Sponsor Role collaborator

Ankang Central Hospital

OTHER

Sponsor Role collaborator

First Affiliated Hospital Xi'an Jiaotong University

OTHER

Sponsor Role collaborator

Xi'an Gaoxin Hospital

OTHER

Sponsor Role collaborator

521 Hospital of NORINCO Group

OTHER

Sponsor Role collaborator

Xi'an No.3 Hospital

OTHER_GOV

Sponsor Role collaborator

Xi'an No.4 Hospital

UNKNOWN

Sponsor Role collaborator

Xi'an No.9 Hospital

UNKNOWN

Sponsor Role collaborator

Xi'an XD Group Hospital

UNKNOWN

Sponsor Role collaborator

Xi'an Traditional Chinese Medicine Hospital

OTHER

Sponsor Role collaborator

Baoji Central Hospital

OTHER

Sponsor Role collaborator

Weinan Central Hospital

OTHER

Sponsor Role collaborator

Tongchuan Mining Hospital

UNKNOWN

Sponsor Role collaborator

Tongchuan People's Hospital

UNKNOWN

Sponsor Role collaborator

Xijing Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Wen Jiang, PhD

Role: STUDY_DIRECTOR

Department of Neurology, Xijing Hospital, Fourth Military Medical University

Locations

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Ankang Central Hospital

Ankang, Shaanxi, China

Site Status

Baoji Central Hospital

Baoji, Shaanxi, China

Site Status

Hanzhong Central Hospital

Hanzhong, Shaanxi, China

Site Status

Shangluo Central Hospital

Shangluo, Shaanxi, China

Site Status

Tongchuan Mining Hospital

Tongchuan, Shaanxi, China

Site Status

Tongchuan People's Hospital

Tongchuan, Shaanxi, China

Site Status

Weinan Central Hospital

Weinan, Shaanxi, China

Site Status

Xi'an 141 Hospital

Xi'an, Shaanxi, China

Site Status

Department of Neurology, Xijing Hospital, Fourth Military Medical University

Xi'an, Shaanxi, China

Site Status

Tangdu Hospital

Xi'an, Shaanxi, China

Site Status

The First Affiliated Hospital of Xi'an Jiaotong University

Xi'an, Shaanxi, China

Site Status

Shaanxi Provincial People's Hospital

Xi'an, Shaanxi, China

Site Status

521 Hospital of NORINCO Group

Xi'an, Shaanxi, China

Site Status

The First Affiliated Hospital of Xi'an Medical University

Xi'an, Shaanxi, China

Site Status

Xi'an Central Hospital

Xi'an, Shaanxi, China

Site Status

Xi'an Gaoxin Hospital

Xi'an, Shaanxi, China

Site Status

Xi'an No.3 Hospital

Xi'an, Shaanxi, China

Site Status

Xi'an No.4 Hospital

Xi'an, Shaanxi, China

Site Status

Xi'an No.9 Hospital

Xi'an, Shaanxi, China

Site Status

Xi'an Traditional Chinese Medicine Hospital

Xi'an, Shaanxi, China

Site Status

Xi'an XD Group Hospital

Xi'an, Shaanxi, China

Site Status

Xianyang Central Hospital

Xianyang, Shaanxi, China

Site Status

215 Hospital of Shaanxi NI

Xianyang, Shaanxi, China

Site Status

Yan'an University Affiliated Hospital

Ya'an, Shaanxi, China

Site Status

Yulin No.2 Hospital

Yulin, Shaanxi, China

Site Status

Yulin No.1 Hospital

Yulin, Shaanxi, China

Site Status

Countries

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China

References

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Sandset EC, Bath PM, Boysen G, Jatuzis D, Korv J, Luders S, Murray GD, Richter PS, Roine RO, Terent A, Thijs V, Berge E; SCAST Study Group. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled, double-blind trial. Lancet. 2011 Feb 26;377(9767):741-50. doi: 10.1016/S0140-6736(11)60104-9.

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Vemmos KN, Spengos K, Tsivgoulis G, Zakopoulos N, Manios E, Kotsis V, Daffertshofer M, Vassilopoulos D. Factors influencing acute blood pressure values in stroke subtypes. J Hum Hypertens. 2004 Apr;18(4):253-9. doi: 10.1038/sj.jhh.1001662.

Reference Type BACKGROUND
PMID: 15037874 (View on PubMed)

AlSibai A, Qureshi AI. Management of Acute Hypertensive Response in Patients With Ischemic Stroke. Neurohospitalist. 2016 Jul;6(3):122-9. doi: 10.1177/1941874416630029. Epub 2016 Apr 21.

Reference Type BACKGROUND
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Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Mar;44(3):870-947. doi: 10.1161/STR.0b013e318284056a. Epub 2013 Jan 31.

Reference Type BACKGROUND
PMID: 23370205 (View on PubMed)

CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet. 1997 Jun 7;349(9066):1641-9.

Reference Type RESULT
PMID: 9186381 (View on PubMed)

Qureshi AI, Ezzeddine MA, Nasar A, Suri MF, Kirmani JF, Hussein HM, Divani AA, Reddi AS. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med. 2007 Jan;25(1):32-8. doi: 10.1016/j.ajem.2006.07.008.

Reference Type RESULT
PMID: 17157679 (View on PubMed)

Castillo J, Leira R, Garcia MM, Serena J, Blanco M, Davalos A. Blood pressure decrease during the acute phase of ischemic stroke is associated with brain injury and poor stroke outcome. Stroke. 2004 Feb;35(2):520-6. doi: 10.1161/01.STR.0000109769.22917.B0. Epub 2004 Jan 15.

Reference Type RESULT
PMID: 14726553 (View on PubMed)

Schrader J, Luders S, Kulschewski A, Berger J, Zidek W, Treib J, Einhaupl K, Diener HC, Dominiak P; Acute Candesartan Cilexetil Therapy in Stroke Survivors Study Group. The ACCESS Study: evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors. Stroke. 2003 Jul;34(7):1699-703. doi: 10.1161/01.STR.0000075777.18006.89. Epub 2003 Jun 19.

Reference Type RESULT
PMID: 12817109 (View on PubMed)

Potter JF, Robinson TG, Ford GA, Mistri A, James M, Chernova J, Jagger C. Controlling hypertension and hypotension immediately post-stroke (CHHIPS): a randomised, placebo-controlled, double-blind pilot trial. Lancet Neurol. 2009 Jan;8(1):48-56. doi: 10.1016/S1474-4422(08)70263-1. Epub 2008 Dec 4.

Reference Type RESULT
PMID: 19058760 (View on PubMed)

Robinson TG, Potter JF, Ford GA, Bulpitt CJ, Chernova J, Jagger C, James MA, Knight J, Markus HS, Mistri AK, Poulter NR; COSSACS Investigators. Effects of antihypertensive treatment after acute stroke in the Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS): a prospective, randomised, open, blinded-endpoint trial. Lancet Neurol. 2010 Aug;9(8):767-75. doi: 10.1016/S1474-4422(10)70163-0.

Reference Type RESULT
PMID: 20621562 (View on PubMed)

He J, Zhang Y, Xu T, Zhao Q, Wang D, Chen CS, Tong W, Liu C, Xu T, Ju Z, Peng Y, Peng H, Li Q, Geng D, Zhang J, Li D, Zhang F, Guo L, Sun Y, Wang X, Cui Y, Li Y, Ma D, Yang G, Gao Y, Yuan X, Bazzano LA, Chen J; CATIS Investigators. Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial. JAMA. 2014 Feb 5;311(5):479-89. doi: 10.1001/jama.2013.282543.

Reference Type RESULT
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Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B, Heeley E, Skulina C, Parsons MW, Kim JS, Tao QL, Li YC, Jiang JD, Tai LW, Zhang JL, Xu E, Cheng Y, Heritier S, Morgenstern LB, Chalmers J; INTERACT Investigators. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol. 2008 May;7(5):391-9. doi: 10.1016/S1474-4422(08)70069-3. Epub 2008 Apr 7.

Reference Type RESULT
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Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, Lindley R, Robinson T, Lavados P, Neal B, Hata J, Arima H, Parsons M, Li Y, Wang J, Heritier S, Li Q, Woodward M, Simes RJ, Davis SM, Chalmers J; INTERACT2 Investigators. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013 Jun 20;368(25):2355-65. doi: 10.1056/NEJMoa1214609. Epub 2013 May 29.

Reference Type RESULT
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Yuan F, Yang F, Zhao J, Fu F, Liu Y, Xue C, Wang K, Yuan X, Li D, Liu Q, Zhang W, Jia Y, He J, Zhou J, Wang X, Lv H, Huo K, Li Z, Zhang B, Wang C, Li L, Li H, Jiang W. Controlling Hypertension After Severe Cerebrovascular Event (CHASE): A randomized, multicenter, controlled study. Int J Stroke. 2021 Jun;16(4):456-465. doi: 10.1177/1747493020932784. Epub 2020 Jun 11.

Reference Type DERIVED
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Yuan F, Yang F, Xue C, Wang K, Liu Q, Zhou J, Fu F, Wang X, Zhang W, Liu Y, Huo K, Lv H, Jiang W; CHASE Study Group. Controlling Hypertension After Severe Cerebrovascular Event (CHASE): study protocol for a randomized controlled trial. Trials. 2018 Feb 21;19(1):130. doi: 10.1186/s13063-018-2530-x.

Reference Type DERIVED
PMID: 29467025 (View on PubMed)

Other Identifiers

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KY20162085-2

Identifier Type: -

Identifier Source: org_study_id

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