OUTREACH: Urine Analysis and Antihypertensive Treatment

NCT ID: NCT03293147

Last Updated: 2024-01-10

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

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-12-18

Study Completion Date

2023-09-30

Brief Summary

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Non-adherence to antihypertensive treatment is one of the leading causes of suboptimal blood pressure control and translates into increased risk of cardiovascular morbidity and mortality. Currently, there is no effective intervention for therapeutic non-adherence. Our project will assess whether high performance liquid chromatography mass spectrometry (HPLC-MS/MS)-guided intervention (providing patients with information on the results of their HPLC-MS/MS-based urine analysis combined with targeting the main reason for non-adherence) leads to an improvement in blood pressure control, adherence and a reduction in healthcare costs. Our multicentre prospective randomised controlled trial consists of 6 stages (screening, recruitment, baseline phenotype assessment, intervention, short-term and long-term outcome visits). The study will fill in an important gap in knowledge on management of blood pressure in non-adherent hypertensive patients beyond the initial diagnostic step. It will also inform the development of a cost-effective model for the management of non-adherence in chronic disorders that require long-term drug therapy.

Detailed Description

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Non-adherence to antihypertensive treatment is one of the leading causes of suboptimal blood pressure control and translates into increased risk of cardiovascular morbidity and mortality. Currently, there is no effective intervention for therapeutic non-adherence.

An ultra-sensitive and highly specific biochemical assay has been developed to detect urinary biomarkers of antihypertensive treatment. The high performance liquid chromatography mass spectrometry (HPLC-MS/MS)-based assay screens spot urine samples for the presence of 40 commonly prescribed blood pressure lowering medications. The results of the test provide a clinician with information on the presence/absence of prescribed antihypertensive drugs or/and their metabolites in urine - a direct confirmation of therapeutic adherence/non-adherence.

The study is a prospective multi-centre randomised controlled trial to examine if HPLC-MS/MS-guided intervention is superior to standard clinical care in improving clinical, behavioural and health-economy outcomes in hypertensive patients who are non-adherent to antihypertensive treatment.

Patient adherence to antihypertensive treatment will be determined at baseline. Non-adherent hypertensive patients at baseline will be randomised in a 1:1 ration to either usual clinical care plus HPLC-MS/MS-guided intervention (Arm A) or usual clinical care only (Arm B).

The study also evaluates a cohort of patients who are adherent to antihypertensive treatment at baseline. Those adherent hypertensive patients will receive the usual clinical care (Arm C). The main purpose of involving this group of patients is to blind the clinical research staff to the adherence status of those patients randomised receiving standard care alone, to prevent introducing any bias in treating non-adherent patients.

Conditions

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Hypertension Adherence, Medication

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Multi-center randomised controlled trial
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators
Participants and clinicians will initially be blinded to the result of the baseline (at trial entry) HPLC-MS/MS based urine test to determine the participant adherence to antihypertensive treatment.

Non-adherent patients allocated to Arm A will be un-blinded at the stage of visit 3 where the results of their HPLC-MS/MS urine test will be revealed to them as a part of HPLC-MS/MS-guided intervention. The doctor will also require un-blinding to provide the required intervention. However, during further study visits the research personnel will remain blinded as to the adherence status of these patients, the results of their HPLC-MS/MS-based analysis and the treatment allocation. The doctor who delivers the intervention will not be involved in collecting clinical information necessary to define outcomes during appointments 4 and 5.

Hypertensive patients randomised to Arms B and C will remain blinded to the results of their HPLC-MS/MS-based urine test throughout all stages of the study.

Study Groups

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Arm A

Intervention group: Non-adherent hypertensive patients randomised in Arm A will receive standard clinical care plus HPLC-MS/MS-guided intervention.

Group Type EXPERIMENTAL

HPLC-MS/MS-guided intervention

Intervention Type OTHER

The HPLC-MS/MS-guided intervention consists of providing partially or totally non-adherent hypertensive patients with information on the results of their HPLC-MS/MS-based urine analysis combined with tailored targeting of the main reason(s) for the deviation from the prescribed antihypertensive treatment

Arm B

Control group: Non-adherent hypertensive patients randomised in Arm B will receive clinical standard care.

Group Type ACTIVE_COMPARATOR

Standard care

Intervention Type OTHER

Standard care for hypertensive patients

Arm C

Control group: Adherent hypertensive patients randomised in Arm C will receive clinical standard care.

Group Type ACTIVE_COMPARATOR

Standard care

Intervention Type OTHER

Standard care for hypertensive patients

Interventions

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HPLC-MS/MS-guided intervention

The HPLC-MS/MS-guided intervention consists of providing partially or totally non-adherent hypertensive patients with information on the results of their HPLC-MS/MS-based urine analysis combined with tailored targeting of the main reason(s) for the deviation from the prescribed antihypertensive treatment

Intervention Type OTHER

Standard care

Standard care for hypertensive patients

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Male or female aged 18 years or above
* Patients previously diagnosed with and pharmacologically managed for hypertension
* Patients with antihypertensive treatment with at least two antihypertensive medications
* Patients have full capability of providing informed consent

Exclusion Criteria

* Patients with recent history of admission to the hospital relating to their hypertension or treatment with anti-hypertensive medications (\<2 weeks) (i)
* Patient refusal for 7-day home-based blood pressure monitoring (7-HBBPM)
* Self-reported pregnancy or breastfeeding
* Female patients planning to conceive within the next 6 months

(i) Including admission to A\&E
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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British Heart Foundation

OTHER

Sponsor Role collaborator

Manchester Academic Health Science Centre

OTHER

Sponsor Role collaborator

Omron Healthcare Co., Ltd.

INDUSTRY

Sponsor Role collaborator

University of Manchester

OTHER

Sponsor Role lead

Responsible Party

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Maciej Tomaszewski

Professor of Cardiovascular Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Maciej Tomaszewski, Prof., MD

Role: PRINCIPAL_INVESTIGATOR

University of Manchester

Locations

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University College London Hospitals NHS Foundation Trust

London, Greater London, United Kingdom

Site Status

Manchester Royal Infirmary

Manchester, Greater Manchester, United Kingdom

Site Status

Ninewells Hospital

Dundee, Scotland, United Kingdom

Site Status

Alvaston Medical Centre

Derby, , United Kingdom

Site Status

Epsom & St. Helier University Hospitals NHS Trust

Epsom, , United Kingdom

Site Status

Glenfield General Hospital

Leicester, , United Kingdom

Site Status

Royal Free Hospital

London, , United Kingdom

Site Status

Guy's and St Thomas' Hospital

London, , United Kingdom

Site Status

Homerton Hospital

London, , United Kingdom

Site Status

St Bartholomews Hospital

London, , United Kingdom

Site Status

Chilwell Valley and Meadows Practice

Nottingham, , United Kingdom

Site Status

University Hospitals Dorset NHS Foundation Trust

Poole, , United Kingdom

Site Status

Countries

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United Kingdom

Other Identifiers

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R120993

Identifier Type: -

Identifier Source: org_study_id

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