The ECLA/PHRI Intervention in the Community Trial

NCT ID: NCT05638009

Last Updated: 2022-12-15

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

2490 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-11-14

Study Completion Date

2023-06-30

Brief Summary

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EPIC is a cluster-randomized, double-blind trial to evaluate the effect of two potassium-enriched salt substitute preparations (one available in the Argentine market and one derived from it), compared to regular salt on systolic blood pressure in subjects ≥ 18 and ≤ 90 years old from Rosario department households in Santa Fe Province, Argentina.

Detailed Description

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The effect of reduced sodium salt preparations has been evaluated in clinical studies (observational and randomized clinical trials) and in meta-analyses, and although a reduction in blood pressure was observed, they have particular characteristics that make them difficult to extrapolate their results to Western populations.

In one of these trials, conducted in rural Indian hypertensive patients, the use of a salt substitute of 75% sodium chloride and 25% potassium chloride showed a significant reduction of systolic blood pressure with a mean difference of -4.58 mmHg in 3 months from baseline to the end of the trial.

Recently, a large cluster-randomized trial conducted in 600 villages in rural areas of five provinces of China (SSaSS trial) among patients with a history of stroke or 60 years of age or elder with elevated blood pressure showed that stroke rates, major cardiovascular events and death from any cause were significantly lower with a salt substitute than with regular salt. The salt substitute used in this trial had 1/3 less sodium than regular salt and substantially more potassium. Therefore, the salt substitute led to an 8% less sodium intake but a 50% higher intake in potassium. This suggests that the greatest impact of salt substitution in this RCT may have been due to an increase in potassium intake rather than the modest decrease in sodium intake that was associated with an average reduction of 2.65 mmHg for SBP (-4.32 to -0.97) and +0.30 mmHg (-0.72 to +1.32) for DBP. In addition, the mean sodium intake in the studied population in this trial was approximately 4.2 gr/d, which is higher than the global average worldwide sodium consumption of 3.9 gr/d. In contrast, potassium intake was lower than the average global potassium intake. Therefore, several considerations that limit the applicability to other populations remain unresolved. The sodium intake of the Chinese rural population is higher than in many other countries, while the potassium intake is relatively low. In addition, in many countries commercially available foods may have added sodium chloride for preservation and thus increase the amount of sodium to the diet. Therefore, the use of salt substitutes would not fully account for salt intake in most cases. Finally, Chinese social and environmental features may be somewhat different to most western countries.

EPIC's investigators stated the hypothesis that salt substitutes could lower systolic blood pressure in a dose-response mode. Therefore, they propose to conduct a randomized cluster trial to evaluate the effect of consuming two doses enriched potassium salt substitutes preparations compared to regular salt intake on systolic blood pressure in individuals from Rosario department.

Conditions

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Hypertension

Keywords

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Sodium Chloride Dietary

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Control

regular salt (99% sodium chloride)

Group Type NO_INTERVENTION

No interventions assigned to this group

Salt substitute 1

Salt substitute 1 is a potassium-enriched salt substitute composed of 66% potassium chloride and 33% sodium chloride

Group Type EXPERIMENTAL

Salt substitute 66%33%

Intervention Type DIETARY_SUPPLEMENT

Salt substitute composed of 66% potassium chloride and 33% sodium chloride

Salt substitute 2

Salt substitute 2 is a potassium-enriched salt substitute composed of 33% potassium chloride and 66% sodium chloride

Group Type EXPERIMENTAL

Salt substitute 33%/66%

Intervention Type DIETARY_SUPPLEMENT

Salt substitute composed of 33% potassium chloride and 66% sodium chloride

Interventions

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Salt substitute 66%33%

Salt substitute composed of 66% potassium chloride and 33% sodium chloride

Intervention Type DIETARY_SUPPLEMENT

Salt substitute 33%/66%

Salt substitute composed of 33% potassium chloride and 66% sodium chloride

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

Subjects ≥ 18 and ≤ 90 years old will be included, with no specific clinical conditions from households that meets the following criteria:

* The household must be composed of at least 2 individuals
* At least 1 of the individuals included must be over 40 years of age
* The household must be located in Rosario department, Santa Fe province, Argentina

Exclusion Criteria

Households will be excluded if a any household member has a at least one of the following contraindication to the salt substitute used in the trial:

* use of a potassium-sparing diuretic
* use of a potassium supplement
* known history of hyperkalemia
* use of salt reduced in sodium and enriched in potassium by medical indication
* do not consume any type of salt for medical indication
* known primary or secondary hyperaldosteronism
* known severe kidney disease (routine biochemical measurement of kidney function will not be performed in household members not included in the study).
* Pregnancy or lactation
* Evidence of hyperkalemia and/or a creatinine clearance (calculated through the CKD-EPI formula \<30 ml/min/1.73m2) in baseline blood laboratory. For those participants who consent to be tested, blood sample will be used. For those participant who has a laboratory test performed with those biomarkers in the past 6 months those results will be considered
* Households in which any of the study participants consume more than 50% of their meals prepared outside their home will also be excluded.
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Population Health Research Institute

OTHER

Sponsor Role collaborator

Estudios Clínicos Latino América

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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María Luz Diaz, MD

Role: PRINCIPAL_INVESTIGATOR

ECLA- Estudios Clínicos Latino América

Locations

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IIC-Instituto de Investigaciones Clínicas

Rosario, Santa Fe Province, Argentina

Site Status RECRUITING

Countries

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Argentina

Central Contacts

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María Luz Diaz, MD

Role: CONTACT

Phone: +54 9 341605-3295

Email: [email protected]

Juan Manuel Dominguez, MD

Role: CONTACT

Phone: +54 9 341210-6243

Email: [email protected]

Other Identifiers

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EPIC. Version 2.0

Identifier Type: -

Identifier Source: org_study_id