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Trial registered on ANZCTR
Registration number
ACTRN12608000041358
Ethics application status
Approved
Date submitted
22/01/2008
Date registered
23/01/2008
Date last updated
16/01/2013
Type of registration
Retrospectively registered
Titles & IDs
Public title
A study to determine the clinical value of measuring central blood pressure in patients with hypertension
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Scientific title
A randomised study to determine the value of central Blood Pressure for GUIDing managEment of hypertension (BP GUIDE Study)
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Secondary ID [1]
252895
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N/A
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Universal Trial Number (UTN)
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Trial acronym
BP GUIDE Study
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Essential hypertension
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Condition category
Condition code
Cardiovascular
2883
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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
Patients with essential hypertension treated by their General Practitioners will be randomised to have treatment decisions (i.e. titration of antihypertensive therapy) based on central blood pressure measures (intervention) versus usual care (control). Central blood pressure will be measured non invasively by radial tonometry using commercial equipment. The duration of intervention is 12 months. All participants will be receiving oral antihypertensive medication upon entry to the study as part of their usual medical care. The dose and frequency of drug administration at study entry will be at the discretion of each participants attending General Practitioner. Recommendations about changing antihypertensive therapy (maintain, decrease or increase medication) will be made throughout the course of the study. These recommendations will be made on the basis of central or brachial blood pressure and the clinical presentation of each individual participant. Recommendations will be provided to each participants attending General Practitioner (there is no standard dose).
A data and safety monitoring committee has not been appointed because we have determined the study to be extremely low risk. Indeed, 1768 patients would be required in each group in order to detect a significant change in 2D LV mass over the course of one year (p=0.001 and 80% power). These calculations are based on an expected change in LV mass of 4.747 g per year, with a standard deviation of 35 at baseline and 37 at one year, as per Framingham data (Lieb W et al. Circ. 2009; 119:3085-3092).
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Intervention code [1]
2495
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Treatment: Other
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Comparator / control treatment
The control treatment refers to usual care of patients with essential hypertension. In other words, treatment decisions about antihypertensive therapy will be guided by blood pressure measures from the upper arm (as well as clinical presentation).
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Control group
Active
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Outcomes
Primary outcome [1]
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The change in left ventricular mass assessed by real time three dimensional echocardiography
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Assessment method [1]
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Timepoint [1]
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Baseline and 12 months
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Primary outcome [2]
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Quality of life assessed by SF36 (short form 36) questionnaire with the addition of the Hypertension specific questionnaire.
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Assessment method [2]
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Timepoint [2]
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Baseline and 12 months
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Primary outcome [3]
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Medication useage assessed by daily defined doseage
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Assessment method [3]
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Timepoint [3]
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Baseline, 3, 6, 9 and 12 months
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Secondary outcome [1]
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Exercise central blood pressure (assessed by radial applanation tonometry during light bicycle exercise)
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Assessment method [1]
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Timepoint [1]
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Baseline and 12 months
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Eligibility
Key inclusion criteria
Essential hypertension
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Minimum age
18
Years
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Maximum age
75
Years
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
Brachial blood pressure >180/100 mmHg. Taking more than 3 antihypertensive drugs. Clinical history of coronary artery disease. Clinical history of renal disease (or serum creatinine >140 umol). Left ventricular hypertrophy (>59 g/m2.7; women and >64 g/ m2.7; men). Secondary causes of hypertension. Aortic valve stenosis or upper limb obstructive atherosclerosis. Pregnant females.
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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)
Allocation is not concealed
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Stratified allocation based on age (> or < 60 years of age)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
16/10/2007
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Actual
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Date of last participant enrolment
Anticipated
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Actual
12/07/2012
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
284
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Recruitment postcode(s) [1]
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4102
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Funding & Sponsors
Funding source category [1]
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Commercial sector/Industry
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Name [1]
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AtCor Medical
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Address [1]
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Unit 11, West Ryde Corporate Centre
1059-1063 Victoria Rd, West Ryde, NSW 2114, Australia
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Country [1]
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Australia
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Funding source category [2]
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University
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Name [2]
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The University of Queensland
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Address [2]
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Department of Medicine
Princess Alexandra Hospital
Woolloongabba, QLD, 4102
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Country [2]
3000
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Australia
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Funding source category [3]
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Government body
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Name [3]
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NHMRC Project Grant
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Address [3]
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NHMRC Canberra, ACT
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Country [3]
243830
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Australia
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Primary sponsor type
University
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Name
The University of Queensland
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Address
Department of Medicine
Princess Alexandra Hospital
Woolloongabba, QLD, 4102
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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]
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Other collaborator category [1]
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Other
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Name [1]
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Dr Walter Abhayaratna
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Address [1]
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Canberra Hospital, Clinical Trials Unit, Canberra, ACT
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Country [1]
251604
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Australia
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Other collaborator category [2]
251605
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Hospital
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Name [2]
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Dr Phillip Roberts-Thomson
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Address [2]
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Royal Hobart Hospital/Menzies Research Institute
Cardiology Department
Hobart, TAS.
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Country [2]
251605
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Princes Alexandra Hospital Human Research Ethics Committee
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Ethics committee address [1]
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Health Services District Princess Alexandra Hospital Woolloongabba, QLD, 4102
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Ethics committee country [1]
4960
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Australia
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Date submitted for ethics approval [1]
4960
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Approval date [1]
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04/10/2008
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Ethics approval number [1]
4960
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2007/090
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Summary
Brief summary
Hypertension is a major risk factor for cardiovascular disease and the most frequent problem managed by General Practitioners (GP’s) in Australia. Blood pressure is traditionally measured by inflating a cuff around the upper arm, and doctors rely on this information when making treatment decisions. However, individuals with the same, or similar, brachial blood pressure may have very different central blood pressure (>30 mmHg difference). This difference is important because central blood pressure has been shown to have greater relevance to the structure and function of the heart and arteries. Moreover, several longitudinal trials show that central blood pressure indices are independently associated with severe cardiovascular events and mortality. When all these data are considered, relying solely on the measure of brachial blood pressure has severe limitations for assessing patient risk and determining the effect of treatment. Indeed, the evidence points toward an expectation that patient care will be improved by tailoring medical treatment based on central, rather than upper arm, blood pressure. However, there is no data to show that using central blood pressure changes decision-making or outcomes and, therefore, doctors continue to rely on brachial blood pressure to make therapeutic decisions. The technology is now available to measure central blood pressure non-invasively by radial applanation tonometry. This methodology should improve patient care by providing the treating clinician with a greater understanding of the “true” risk relating to blood pressure control and, therefore, make more appropriate treatment decisions. This research program aims to bridge the gap between the current method of managing patients with hypertension (focus on upper arm blood pressure) and the theoretical improvement in the quality of patient care that may be achieved with the use of new technology and consideration of central blood pressure. The research should provide the foundation model for a new way to undertake management of patients with hypertension. It is hypothesised that patients randomised to have treatment decisions based on central blood pressure will have no significant change in left ventricular mass; will have less use of medication and improved quality of life scores.
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Trial website
Nil
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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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Dr James Sharman
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Address
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Menzies Research Institute, University of Tasmania Private Bag 23 Hobart TAS 7001
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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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+61 3 6226 7755
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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, University of Tasmania Private Bag 23 Hobart TAS 7001
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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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+61 3 6226 7755
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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,
University of Tasmania
Private Bag 23
Hobart TAS 7001
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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
2402
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+61 3 6226 7755
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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
Guiding Hypertension Management Using Central Blood Pressure: Effect of Medication Withdrawal on Left Ventricular Function.
2016
https://dx.doi.org/10.1093/ajh/hpv108
N.B. These documents automatically identified may not have been verified by the study sponsor.
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