Hypertension
Conditions
Brief summary
This is an out-patient based prospective, multi-centre, observational post-marketing surveillance study amongst internists and cardiologists. In this study, patients with essential hypertension and at least one additional risk factor will be included. Patients may take any antihypertensive treatment which is approved for cardiovascular protection including Micardis 80 mg / Micardis Plus. Patients will be followed over one year in four visits from baseline to endpoint with an additional visit before and after the month of Ramadan.
Detailed description
Purpose:
Interventions
None listed
Sponsors
Study design
Eligibility
Inclusion criteria
1. Male or female of age 18 years or older; 2. Newly diagnosed and untreated or previously treated and uncontrolled patients with essential hypertension; 3. Seated blood pressure of \>140/90 mmHg or \>130/80 mmHg in patients with diabetes mellitus or chronic kidney disease; 4. Patients with at least one cardiovascular (cv) risk factor; 5. Ability to provide written informed consent.
Exclusion criteria
1. Patients with contraindications to the prescribed antihypertensive medications; 2. Pregnant or lactating women or women of childbearing potential not using an acceptable method of contraception; 3. Patients who are participating in any other study protocol.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Achievement of the JNC 7 Treatment Goals (BP <140/90 mmHg) at Week 52 | Up to 52 weeks | The proportion of patients enrolled in the study who achieve the JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) treatment goals (blood pressure (BP) \<140/90 mmHg) in a primary-care setting at week 52. This variable was derived from the mean sitting blood pressure assessed by the investigators at week 52. To achieve JNC 7 treatment goals, the subject had to satisfy both blood pressure criteria - systolic blood pressure below 140 mm Hg and diastolic blood pressure below 90 mm Hg. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cardiovascular Events | Up to 52 weeks | Percentage of participants who experienced a major cardiovascular (CV) event |
| The Overall Assessment of Treatment by Patients at 52 Weeks | Up to 52 weeks | The overall assessment of treatment by patients at 52 weeks. Assessed using a verbal rating scale with 5 categories: Outstanding, very satisfactory, satisfactory, marginal and not satisfactory. |
| The Overall Assessment of Treatment by Physicians at 52 Weeks | Up to 52 weeks | The overall assessment of treatment by physicians at 52 weeks. Assessed using a verbal rating scale with 5 categories: Outstanding, very satisfactory, satisfactory, marginal and not satisfactory. |
| Compliance of Patients up to 10 Days Before Ramadan | 10 days before Ramadan | Compliance of patients up to 10 days before ramadan (treated by internists and cardiologists as primary physician). Subjects were asked how often they have not taken their medicine and were given five possible choices from none of the time to all of the time. |
| Compliance of Patients up to 10 Days After Ramadan | 10 days after Ramadan | Compliance of patients up to 10 days after Ramadan (treated by internists and cardiologists as primary physician). Subjects were asked how often they have not taken their medicine and were given five possible choices from none of the time to all of the time. |
| Achieving JNC 7 Treatment Goals After Ramadan | 1 month | The proportion of patients enrolled in the study who achieve the JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) treatment goals (blood pressure (BP) \<140/90 mmHg) in a primary-care setting after Ramadan. This variable was derived from the mean sitting blood pressure assessed by the investigators after Ramadan. To achieve JNC 7 treatment goals, the subject had to satisfy both blood pressure criteria - systolic blood pressure below 140 mm Hg and diastolic blood pressure below 90 mm Hg. |
| Achievement of the JNC 7 Treatment Goals During the Whole Study Duration (Treated by Internists and Cardiologists as Primary Physician) | Up to 52 weeks | Proportion of patients who achieved the JNC 7 treatment goals during the whole study duration (treated by internists and cardiologists as primary physician) |
| The Difference in Systolic Blood Pressure Before and After the Month of Ramadan | Baseline, 10 days before Ramadan, 10 days after Ramadan and 52 weeks | Change from baseline in systolic blood pressure before and after the month of Ramadan |
| The Difference in Diastolic Blood Pressure Before and After the Month of Ramadan | Baseline, 10 days before Ramadan, 10 days after Ramadan and 52 weeks | Change from baseline in diastolic blood pressure before and after the month of Ramadan |
| The Percentage of Patients Achieving JNC 7 Treatment Goals at the End of the 1 Year Treatment Duration | Up to 52 weeks | The proportion of patients enrolled in the study who achieve the JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) treatment goals (blood pressure (BP) \<140/90 mmHg) in a primary-care setting at the end of the 1 year treatment duration. This variable was derived from the mean sitting blood pressure assessed by the investigators at the end of the 1 year treatment duration. To achieve JNC 7 treatment goals, the subject had to satisfy both blood pressure criteria - systolic blood pressure below 140 mm Hg and diastolic blood pressure below 90 mm Hg. At this timepoint, a diagnosis of diabetes mellitus and/or kidney disease was also taken into account. Subjects with either of the mentioned conditions had to have systolic blood pressure lower than 130 mm Hg and diastolic blood pressure below 80 mm Hg to satisfy JNC 7 treatment goals. |
| Adverse Events Under Angiotensin II (Type 1) Receptor Blockers (ARBs) Treatment When Given in Combination With Calcium-Channel Blockers (CCBs) | Up to 52 weeks | Number of participants with adverse events in participants receiving Angiotensin II (Type 1) Receptor Blockers (ARBs) when given in combination with Calcium-Channel Blockers (CCBs) during the whole study duration. |
| Compliance of Patients During the Whole Study Duration (52 Weeks) | Up to 52 weeks | Compliance of patients during the whole study duration (treated by internists and cardiologists as primary physician). Subjects were asked how often they have not taken their medicine and were given five possible choices from none of the time to all of the time. |
Countries
Algeria, Egypt, Lebanon, Saudi Arabia, United Arab Emirates
Participant flow
Recruitment details
Patients are included a non-completers if they did not meet the definition of the intention-to-treat (ITT) population (all patients, who received at least one dose of study medication) or if the subject attended the week 52 visit less than 26 weeks after baseline.
Participants by arm
| Arm | Count |
|---|---|
| All Subjects Newly diagnosed or uncontrolled adult hypertensive patients with at least one cardiovascular risk factor who are prescribed antihypertensive drugs with an approved indication for cardiovascular protection (including Micardis® 80 mg/ Micardis® Plus tablets) as monotherapy or as part of a combination regimen with other antihypertensive agents.
All antihypertensive drugs will be prescribed and administered according to the approved prescribing information in the country where the patient resides. Treatment duration is up to 52 weeks. | 2,090 |
| Total | 2,090 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | End of treatment visit too early | 33 |
| Overall Study | Lost to follow-up or no valid BP measure | 336 |
| Overall Study | Not meet ITT population definition | 58 |
| Overall Study | Violated inclusion criteria | 2 |
Baseline characteristics
| Characteristic | All Subjects |
|---|---|
| Age, Continuous | 54.78 years STANDARD_DEVIATION 11.01 |
| Gender Female | 808 participants |
| Gender Male | 1161 participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 2,090 |
| serious Total, serious adverse events | 21 / 2,090 |
Outcome results
Achievement of the JNC 7 Treatment Goals (BP <140/90 mmHg) at Week 52
The proportion of patients enrolled in the study who achieve the JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) treatment goals (blood pressure (BP) \<140/90 mmHg) in a primary-care setting at week 52. This variable was derived from the mean sitting blood pressure assessed by the investigators at week 52. To achieve JNC 7 treatment goals, the subject had to satisfy both blood pressure criteria - systolic blood pressure below 140 mm Hg and diastolic blood pressure below 90 mm Hg.
Time frame: Up to 52 weeks
Population: ITT dataset which included all patients, who received at least one dose of study medication.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Subjects | Achievement of the JNC 7 Treatment Goals (BP <140/90 mmHg) at Week 52 | Yes | 94.95 Percentage of participants |
| All Subjects | Achievement of the JNC 7 Treatment Goals (BP <140/90 mmHg) at Week 52 | No | 5.05 Percentage of participants |
Achievement of the JNC 7 Treatment Goals During the Whole Study Duration (Treated by Internists and Cardiologists as Primary Physician)
Proportion of patients who achieved the JNC 7 treatment goals during the whole study duration (treated by internists and cardiologists as primary physician)
Time frame: Up to 52 weeks
Population: Per-protocol population
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Subjects | Achievement of the JNC 7 Treatment Goals During the Whole Study Duration (Treated by Internists and Cardiologists as Primary Physician) | Yes | 96.64 Percentage of participants |
| All Subjects | Achievement of the JNC 7 Treatment Goals During the Whole Study Duration (Treated by Internists and Cardiologists as Primary Physician) | No | 3.36 Percentage of participants |
| Non-Fasting | Achievement of the JNC 7 Treatment Goals During the Whole Study Duration (Treated by Internists and Cardiologists as Primary Physician) | Yes | 93.98 Percentage of participants |
| Non-Fasting | Achievement of the JNC 7 Treatment Goals During the Whole Study Duration (Treated by Internists and Cardiologists as Primary Physician) | No | 6.02 Percentage of participants |
Achieving JNC 7 Treatment Goals After Ramadan
The proportion of patients enrolled in the study who achieve the JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) treatment goals (blood pressure (BP) \<140/90 mmHg) in a primary-care setting after Ramadan. This variable was derived from the mean sitting blood pressure assessed by the investigators after Ramadan. To achieve JNC 7 treatment goals, the subject had to satisfy both blood pressure criteria - systolic blood pressure below 140 mm Hg and diastolic blood pressure below 90 mm Hg.
Time frame: 1 month
Population: Per-protocol (PP) population which included all eligible patients who did not experience any protocol violation and were treated with the study medication up to week 52 (study completers) according to the prescribing information.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Subjects | Achieving JNC 7 Treatment Goals After Ramadan | Yes | 87.07 Percentage of participants |
| All Subjects | Achieving JNC 7 Treatment Goals After Ramadan | No | 12.93 Percentage of participants |
| Non-Fasting | Achieving JNC 7 Treatment Goals After Ramadan | Yes | 85.97 Percentage of participants |
| Non-Fasting | Achieving JNC 7 Treatment Goals After Ramadan | No | 14.02 Percentage of participants |
Adverse Events Under Angiotensin II (Type 1) Receptor Blockers (ARBs) Treatment When Given in Combination With Calcium-Channel Blockers (CCBs)
Number of participants with adverse events in participants receiving Angiotensin II (Type 1) Receptor Blockers (ARBs) when given in combination with Calcium-Channel Blockers (CCBs) during the whole study duration.
Time frame: Up to 52 weeks
Population: All subjects who took a combination of ARB and CCB drugs.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Subjects | Adverse Events Under Angiotensin II (Type 1) Receptor Blockers (ARBs) Treatment When Given in Combination With Calcium-Channel Blockers (CCBs) | 27 participants |
Cardiovascular Events
Percentage of participants who experienced a major cardiovascular (CV) event
Time frame: Up to 52 weeks
Population: All subjects included in the study according to the study protocol i.e. patients who did not violate any inclusion or exclusion criteria
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Subjects | Cardiovascular Events | 0.91 Percentage of participants |
Compliance of Patients During the Whole Study Duration (52 Weeks)
Compliance of patients during the whole study duration (treated by internists and cardiologists as primary physician). Subjects were asked how often they have not taken their medicine and were given five possible choices from none of the time to all of the time.
Time frame: Up to 52 weeks
Population: Per-protocol population including all patients with data at 52 weeks
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Subjects | Compliance of Patients During the Whole Study Duration (52 Weeks) | None of the time | 70.68 Percentage of participants |
| All Subjects | Compliance of Patients During the Whole Study Duration (52 Weeks) | Some of the time | 25.78 Percentage of participants |
| All Subjects | Compliance of Patients During the Whole Study Duration (52 Weeks) | Most of the time | 1.98 Percentage of participants |
| All Subjects | Compliance of Patients During the Whole Study Duration (52 Weeks) | All the time | 0.48 Percentage of participants |
| All Subjects | Compliance of Patients During the Whole Study Duration (52 Weeks) | Do not know | 1.08 Percentage of participants |
Compliance of Patients up to 10 Days After Ramadan
Compliance of patients up to 10 days after Ramadan (treated by internists and cardiologists as primary physician). Subjects were asked how often they have not taken their medicine and were given five possible choices from none of the time to all of the time.
Time frame: 10 days after Ramadan
Population: Per-protocol population including all patients with data 10 days after Ramadan
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Subjects | Compliance of Patients up to 10 Days After Ramadan | None of the time | 71.11 Percentage of participants |
| All Subjects | Compliance of Patients up to 10 Days After Ramadan | Some of the time | 24.37 Percentage of participants |
| All Subjects | Compliance of Patients up to 10 Days After Ramadan | Most of the time | 2.40 Percentage of participants |
| All Subjects | Compliance of Patients up to 10 Days After Ramadan | All the time | 0.80 Percentage of participants |
| All Subjects | Compliance of Patients up to 10 Days After Ramadan | Do not know | 1.32 Percentage of participants |
Compliance of Patients up to 10 Days Before Ramadan
Compliance of patients up to 10 days before ramadan (treated by internists and cardiologists as primary physician). Subjects were asked how often they have not taken their medicine and were given five possible choices from none of the time to all of the time.
Time frame: 10 days before Ramadan
Population: Per-protocol population including all patients with data 10 days before Ramadan
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Subjects | Compliance of Patients up to 10 Days Before Ramadan | None of the time | 70.58 Percentage of participants |
| All Subjects | Compliance of Patients up to 10 Days Before Ramadan | Some of the time | 25.45 Percentage of participants |
| All Subjects | Compliance of Patients up to 10 Days Before Ramadan | Most of the time | 0.95 Percentage of participants |
| All Subjects | Compliance of Patients up to 10 Days Before Ramadan | All the time | 1.06 Percentage of participants |
| All Subjects | Compliance of Patients up to 10 Days Before Ramadan | Do not know | 1.96 Percentage of participants |
The Difference in Diastolic Blood Pressure Before and After the Month of Ramadan
Change from baseline in diastolic blood pressure before and after the month of Ramadan
Time frame: Baseline, 10 days before Ramadan, 10 days after Ramadan and 52 weeks
Population: Per-protocol population
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| All Subjects | The Difference in Diastolic Blood Pressure Before and After the Month of Ramadan | 10 days before Ramadan (N=1200, 153) | 12.2 mmHg | Standard Deviation 9.6 |
| All Subjects | The Difference in Diastolic Blood Pressure Before and After the Month of Ramadan | 10 days after Ramadan (N=1190, 160) | 14.4 mmHg | Standard Deviation 9.6 |
| All Subjects | The Difference in Diastolic Blood Pressure Before and After the Month of Ramadan | 52 weeks (N=1210, 160) | 15.5 mmHg | Standard Deviation 9.9 |
| Non-Fasting | The Difference in Diastolic Blood Pressure Before and After the Month of Ramadan | 10 days before Ramadan (N=1200, 153) | 12.5 mmHg | Standard Deviation 10.4 |
| Non-Fasting | The Difference in Diastolic Blood Pressure Before and After the Month of Ramadan | 10 days after Ramadan (N=1190, 160) | 15.1 mmHg | Standard Deviation 9.2 |
| Non-Fasting | The Difference in Diastolic Blood Pressure Before and After the Month of Ramadan | 52 weeks (N=1210, 160) | 16.2 mmHg | Standard Deviation 10.2 |
The Difference in Systolic Blood Pressure Before and After the Month of Ramadan
Change from baseline in systolic blood pressure before and after the month of Ramadan
Time frame: Baseline, 10 days before Ramadan, 10 days after Ramadan and 52 weeks
Population: Per-protocol population
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| All Subjects | The Difference in Systolic Blood Pressure Before and After the Month of Ramadan | 10 days after Ramadan (N=1190, 160) | 28.3 mmHg | Standard Deviation 17 |
| All Subjects | The Difference in Systolic Blood Pressure Before and After the Month of Ramadan | 10 days before Ramadan (N=1200, 153) | 24.4 mmHg | Standard Deviation 16.7 |
| All Subjects | The Difference in Systolic Blood Pressure Before and After the Month of Ramadan | 52 weeks (N=1210, 160) | 30.3 mmHg | Standard Deviation 17.2 |
| Non-Fasting | The Difference in Systolic Blood Pressure Before and After the Month of Ramadan | 10 days before Ramadan (N=1200, 153) | 25.0 mmHg | Standard Deviation 16.3 |
| Non-Fasting | The Difference in Systolic Blood Pressure Before and After the Month of Ramadan | 10 days after Ramadan (N=1190, 160) | 29.3 mmHg | Standard Deviation 15 |
| Non-Fasting | The Difference in Systolic Blood Pressure Before and After the Month of Ramadan | 52 weeks (N=1210, 160) | 30.6 mmHg | Standard Deviation 15.9 |
The Overall Assessment of Treatment by Patients at 52 Weeks
The overall assessment of treatment by patients at 52 weeks. Assessed using a verbal rating scale with 5 categories: Outstanding, very satisfactory, satisfactory, marginal and not satisfactory.
Time frame: Up to 52 weeks
Population: Per-protocol population
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Subjects | The Overall Assessment of Treatment by Patients at 52 Weeks | Outstanding | 25.45 Percentage of participants |
| All Subjects | The Overall Assessment of Treatment by Patients at 52 Weeks | Very satisfactory | 53.88 Percentage of participants |
| All Subjects | The Overall Assessment of Treatment by Patients at 52 Weeks | Satisfactory | 18.80 Percentage of participants |
| All Subjects | The Overall Assessment of Treatment by Patients at 52 Weeks | Marginal | 1.42 Percentage of participants |
| All Subjects | The Overall Assessment of Treatment by Patients at 52 Weeks | Not satisfactory | 0.45 Percentage of participants |
The Overall Assessment of Treatment by Physicians at 52 Weeks
The overall assessment of treatment by physicians at 52 weeks. Assessed using a verbal rating scale with 5 categories: Outstanding, very satisfactory, satisfactory, marginal and not satisfactory.
Time frame: Up to 52 weeks
Population: Per-protocol population
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Subjects | The Overall Assessment of Treatment by Physicians at 52 Weeks | Outstanding | 25.97 Percentage of participants |
| All Subjects | The Overall Assessment of Treatment by Physicians at 52 Weeks | Very satisfactory | 55.49 Percentage of participants |
| All Subjects | The Overall Assessment of Treatment by Physicians at 52 Weeks | Satisfactory | 16.21 Percentage of participants |
| All Subjects | The Overall Assessment of Treatment by Physicians at 52 Weeks | Marginal | 1.74 Percentage of participants |
| All Subjects | The Overall Assessment of Treatment by Physicians at 52 Weeks | Not satisfactory | 0.58 Percentage of participants |
The Percentage of Patients Achieving JNC 7 Treatment Goals at the End of the 1 Year Treatment Duration
The proportion of patients enrolled in the study who achieve the JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) treatment goals (blood pressure (BP) \<140/90 mmHg) in a primary-care setting at the end of the 1 year treatment duration. This variable was derived from the mean sitting blood pressure assessed by the investigators at the end of the 1 year treatment duration. To achieve JNC 7 treatment goals, the subject had to satisfy both blood pressure criteria - systolic blood pressure below 140 mm Hg and diastolic blood pressure below 90 mm Hg. At this timepoint, a diagnosis of diabetes mellitus and/or kidney disease was also taken into account. Subjects with either of the mentioned conditions had to have systolic blood pressure lower than 130 mm Hg and diastolic blood pressure below 80 mm Hg to satisfy JNC 7 treatment goals.
Time frame: Up to 52 weeks
Population: Per-protocol population
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Subjects | The Percentage of Patients Achieving JNC 7 Treatment Goals at the End of the 1 Year Treatment Duration | Yes | 85.93 Percentage of participants |
| All Subjects | The Percentage of Patients Achieving JNC 7 Treatment Goals at the End of the 1 Year Treatment Duration | No | 14.07 Percentage of participants |