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Trial registered on ANZCTR
Registration number
ACTRN12613000053729
Ethics application status
Approved
Date submitted
13/12/2012
Date registered
16/01/2013
Date last updated
15/03/2016
Type of registration
Prospectively registered
Titles & IDs
Public title
Targeted lowering of central blood pressure in patients with hypertension: a randomised controlled trial
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Scientific title
Effect on left ventricular mass with targeted lowering of central blood pressure using spironolactone in patients with hypertension: a randomised controlled trial
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Secondary ID [1]
281678
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Nil
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Universal Trial Number (UTN)
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Trial acronym
The LOWCBP Study
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
High blood pressure
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Condition category
Condition code
Cardiovascular
288349
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0
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Hypertension
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Oral spironolactone, 25 mg/d, over 2 years
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
standard treatment of hypertension involving care supervised by the participants general practitioner
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Control group
Active
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Outcomes
Primary outcome [1]
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Left ventricular mass by magnetic resonance imaging
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Assessment method [1]
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Timepoint [1]
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2 years
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Secondary outcome [1]
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Clinic and home blood pressures (measured using automated devices) and 24 hour ambulatory blood pressure.
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Assessment method [1]
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Timepoint [1]
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2 years
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Secondary outcome [2]
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Aortic stiffness by tonometry and magnetic resonance imaging
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Assessment method [2]
300366
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Timepoint [2]
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2 years
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Secondary outcome [3]
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Quality of life using SF-36 and Bulpitt health surveys
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Assessment method [3]
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Timepoint [3]
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2 years
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Eligibility
Key inclusion criteria
*Aged 18 – 70 years on stable antihypertensive therapy (at least one month).
*Taking at least one, but no more than three, antihypertensive drugs to lower BP (rationale for no more than 3 drugs is that this will rule out cases of complicated or resistant hypertension which may require special attention beyond this study protocol).
*Seated brachial BP <140/90 mmHg (controlled brachial BP).
*Seated central SBP greater than or equal to +0.5SD of age- and gender-specific normal values (uncontrolled central BP).
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Minimum age
18
Years
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Maximum age
70
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
*Seated brachial BP greater than or equal to 140/90 mmHg (uncontrolled brachial BP)
*Seated brachial BP <140/90 mmHg but central SBP below +0.5SD of age- and gender-specific normal values
*Women who are pregnant, breastfeeding or of child bearing age with intending pregnancy.
*Concomitant therapy with both ACEi and ARB (due to risk of hyperkalaemia).
*Therapy with digoxin or lithium or nondepolarizing skeletal muscle relaxants (e.g. Tubocurarine).
*A clinical history of CVD which may affect estimation of central BP or complicate therapeutic decisions. This includes; established coronary artery disease, coronary artery bypass graft surgery, aortic valve stenosis (gradient >20 mmHg), systolic heart failure or ejection fraction <50% or other serious cardiovascular event within 6 months of enrolment.
*Chronic use of sex hormone therapy or non-steroidal anti-inflammatory drugs
*Using any aldosterone inhibitor (eplereone, spironolactone) within 30 days of enrolment.
*Contraindication to spironolactone including; anuria, acute renal insufficiency, significant impairment of renal excretory function (creatinine clearance less than or equal to 50 mL/min [Cockcroft-Gault formula]) or hyperkalemia (plasma potassium >5.0 mmol/l at initiation).
*Using potassium supplements or potassium-sparing diuretics (e.g. amiloride or triamterene).
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Central randomisation by computer
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Permuted block randomisation with stratification based on 2D echo LV mass, age, sex and centre.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
Prospective Randomised Open label Blinded Endpoint
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Between-group differences in endpoints over time will be assessed by multiple regression analysis controlling for cardiovascular risk factors
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Recruitment
Recruitment status
Active, not recruiting
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Date of first participant enrolment
Anticipated
14/01/2013
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Actual
25/02/2013
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Date of last participant enrolment
Anticipated
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Actual
11/03/2016
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
300
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Accrual to date
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Final
307
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Recruitment in Australia
Recruitment state(s)
ACT,QLD,TAS
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Funding & Sponsors
Funding source category [1]
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Government body
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Name [1]
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National Health and Medical Research Council of Australia
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Address [1]
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National Health and Medical Research Council
GPO Box 1421
Canberra ACT 2601
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
James Sharman
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Address
Menzies Research Institute Tasmania
17 Liverpool Street,
Hobart, 7000 TAS
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
285255
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Human Research Ethics Committee (Tasmania)
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Ethics committee address [1]
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Office of Research Services University of Tasmania Private Bag 1 Hobart TAS 7001
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
288543
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Approval date [1]
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01/06/2012
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Ethics approval number [1]
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H0012445
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Summary
Brief summary
High blood pressure (BP) is the most common modifiable cause of death from cardiovascular disease (CVD). Lowering BP with medication improves patient outcomes, but even in populations with normal upper arm (brachial) BP there remains considerable residual risk for CVD. Our recent pilot work found that much of this risk may be due to persistently elevated central BP. However, there has never been a trial to determine the clinical value of targeted central BP lowering. This remains the most significant question to be answered before central BP can be considered for routine clinical use, and is the aim of this project. The proposed study will be a multi-centre, prospective, randomized, open-label, blinded endpoint (PROBE) trial over two years in 300 patients treated for hypertension who have controlled brachial BP but relatively high central BP. Randomisation to spironolactone (and lowering of central BP) is expected to significantly improve CVD risk, despite no significant change in clinic measured brachial BP.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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A/Prof James Sharman
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Address
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Menzies Research Institute Tasmania
17 Liverpool Street, Hobart, TAS, 7000
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Country
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Australia
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Phone
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+61 3 6226 4709
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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James Sharman
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Address
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Menzies Research Institute Tasmania
17 Liverpool Street, Hobart, TAS, 7000
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Country
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Australia
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Phone
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+61 3 6226 4709
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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James Sharman
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Address
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Menzies Research Institute Tasmania
17 Liverpool Street, Hobart, TAS, 7000
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Country
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Australia
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Phone
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+61 3 6226 4709
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Comparison of central blood pressure estimated by a cuff-based device with radial tonometry.
2016
https://dx.doi.org/10.1093/ajh/hpw063
Embase
Facebook advertising for participant recruitment into a blood pressure clinical trial.
2017
https://dx.doi.org/10.1097/HJH.0000000000001477
N.B. These documents automatically identified may not have been verified by the study sponsor.
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