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Impact of Ramadan on Achieving Joint National Committee (JNC) 7 Treatment Goals in CV Risk Patients

Treatment Adherence to JNC 7(Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, 7th Report) Guidelines in Cardiovascular (CV)-Risk Patients Across the Middle East - the Impact of Ramadan Fasting on Achieving Treatment Goals in Daily Practice

Status
Completed
Phases
Unknown
Study type
Observational
Source
ClinicalTrials.gov
Registry ID
NCT01853839
Enrollment
1674
Registered
2013-05-15
Start date
2011-10-31
Completion date
2014-07-31
Last updated
2015-08-10

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Hypertension

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

Boehringer Ingelheim
Lead SponsorINDUSTRY

Study design

Observational model
CASE_ONLY
Time perspective
PROSPECTIVE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Achievement of the JNC 7 Treatment Goals (BP <140/90 mmHg) at Week 52Up to 52 weeksThe 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

MeasureTime frameDescription
Cardiovascular EventsUp to 52 weeksPercentage of participants who experienced a major cardiovascular (CV) event
The Overall Assessment of Treatment by Patients at 52 WeeksUp to 52 weeksThe 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 WeeksUp to 52 weeksThe 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 Ramadan10 days before RamadanCompliance 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 Ramadan10 days after RamadanCompliance 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 Ramadan1 monthThe 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 weeksProportion 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 RamadanBaseline, 10 days before Ramadan, 10 days after Ramadan and 52 weeksChange 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 RamadanBaseline, 10 days before Ramadan, 10 days after Ramadan and 52 weeksChange 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 DurationUp to 52 weeksThe 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 weeksNumber 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 weeksCompliance 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

ArmCount
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
Total2,090

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyEnd of treatment visit too early33
Overall StudyLost to follow-up or no valid BP measure336
Overall StudyNot meet ITT population definition58
Overall StudyViolated inclusion criteria2

Baseline characteristics

CharacteristicAll Subjects
Age, Continuous54.78 years
STANDARD_DEVIATION 11.01
Gender
Female
808 participants
Gender
Male
1161 participants

Adverse events

Event typeEG000
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

Primary

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.

ArmMeasureGroupValue (NUMBER)
All SubjectsAchievement of the JNC 7 Treatment Goals (BP <140/90 mmHg) at Week 52Yes94.95 Percentage of participants
All SubjectsAchievement of the JNC 7 Treatment Goals (BP <140/90 mmHg) at Week 52No5.05 Percentage of participants
Secondary

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

ArmMeasureGroupValue (NUMBER)
All SubjectsAchievement of the JNC 7 Treatment Goals During the Whole Study Duration (Treated by Internists and Cardiologists as Primary Physician)Yes96.64 Percentage of participants
All SubjectsAchievement of the JNC 7 Treatment Goals During the Whole Study Duration (Treated by Internists and Cardiologists as Primary Physician)No3.36 Percentage of participants
Non-FastingAchievement of the JNC 7 Treatment Goals During the Whole Study Duration (Treated by Internists and Cardiologists as Primary Physician)Yes93.98 Percentage of participants
Non-FastingAchievement of the JNC 7 Treatment Goals During the Whole Study Duration (Treated by Internists and Cardiologists as Primary Physician)No6.02 Percentage of participants
Secondary

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.

ArmMeasureGroupValue (NUMBER)
All SubjectsAchieving JNC 7 Treatment Goals After RamadanYes87.07 Percentage of participants
All SubjectsAchieving JNC 7 Treatment Goals After RamadanNo12.93 Percentage of participants
Non-FastingAchieving JNC 7 Treatment Goals After RamadanYes85.97 Percentage of participants
Non-FastingAchieving JNC 7 Treatment Goals After RamadanNo14.02 Percentage of participants
Secondary

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.

ArmMeasureValue (NUMBER)
All SubjectsAdverse Events Under Angiotensin II (Type 1) Receptor Blockers (ARBs) Treatment When Given in Combination With Calcium-Channel Blockers (CCBs)27 participants
Secondary

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

ArmMeasureValue (NUMBER)
All SubjectsCardiovascular Events0.91 Percentage of participants
Secondary

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

ArmMeasureGroupValue (NUMBER)
All SubjectsCompliance of Patients During the Whole Study Duration (52 Weeks)None of the time70.68 Percentage of participants
All SubjectsCompliance of Patients During the Whole Study Duration (52 Weeks)Some of the time25.78 Percentage of participants
All SubjectsCompliance of Patients During the Whole Study Duration (52 Weeks)Most of the time1.98 Percentage of participants
All SubjectsCompliance of Patients During the Whole Study Duration (52 Weeks)All the time0.48 Percentage of participants
All SubjectsCompliance of Patients During the Whole Study Duration (52 Weeks)Do not know1.08 Percentage of participants
Secondary

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

ArmMeasureGroupValue (NUMBER)
All SubjectsCompliance of Patients up to 10 Days After RamadanNone of the time71.11 Percentage of participants
All SubjectsCompliance of Patients up to 10 Days After RamadanSome of the time24.37 Percentage of participants
All SubjectsCompliance of Patients up to 10 Days After RamadanMost of the time2.40 Percentage of participants
All SubjectsCompliance of Patients up to 10 Days After RamadanAll the time0.80 Percentage of participants
All SubjectsCompliance of Patients up to 10 Days After RamadanDo not know1.32 Percentage of participants
Secondary

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

ArmMeasureGroupValue (NUMBER)
All SubjectsCompliance of Patients up to 10 Days Before RamadanNone of the time70.58 Percentage of participants
All SubjectsCompliance of Patients up to 10 Days Before RamadanSome of the time25.45 Percentage of participants
All SubjectsCompliance of Patients up to 10 Days Before RamadanMost of the time0.95 Percentage of participants
All SubjectsCompliance of Patients up to 10 Days Before RamadanAll the time1.06 Percentage of participants
All SubjectsCompliance of Patients up to 10 Days Before RamadanDo not know1.96 Percentage of participants
Secondary

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

ArmMeasureGroupValue (MEAN)Dispersion
All SubjectsThe Difference in Diastolic Blood Pressure Before and After the Month of Ramadan10 days before Ramadan (N=1200, 153)12.2 mmHgStandard Deviation 9.6
All SubjectsThe Difference in Diastolic Blood Pressure Before and After the Month of Ramadan10 days after Ramadan (N=1190, 160)14.4 mmHgStandard Deviation 9.6
All SubjectsThe Difference in Diastolic Blood Pressure Before and After the Month of Ramadan52 weeks (N=1210, 160)15.5 mmHgStandard Deviation 9.9
Non-FastingThe Difference in Diastolic Blood Pressure Before and After the Month of Ramadan10 days before Ramadan (N=1200, 153)12.5 mmHgStandard Deviation 10.4
Non-FastingThe Difference in Diastolic Blood Pressure Before and After the Month of Ramadan10 days after Ramadan (N=1190, 160)15.1 mmHgStandard Deviation 9.2
Non-FastingThe Difference in Diastolic Blood Pressure Before and After the Month of Ramadan52 weeks (N=1210, 160)16.2 mmHgStandard Deviation 10.2
Secondary

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

ArmMeasureGroupValue (MEAN)Dispersion
All SubjectsThe Difference in Systolic Blood Pressure Before and After the Month of Ramadan10 days after Ramadan (N=1190, 160)28.3 mmHgStandard Deviation 17
All SubjectsThe Difference in Systolic Blood Pressure Before and After the Month of Ramadan10 days before Ramadan (N=1200, 153)24.4 mmHgStandard Deviation 16.7
All SubjectsThe Difference in Systolic Blood Pressure Before and After the Month of Ramadan52 weeks (N=1210, 160)30.3 mmHgStandard Deviation 17.2
Non-FastingThe Difference in Systolic Blood Pressure Before and After the Month of Ramadan10 days before Ramadan (N=1200, 153)25.0 mmHgStandard Deviation 16.3
Non-FastingThe Difference in Systolic Blood Pressure Before and After the Month of Ramadan10 days after Ramadan (N=1190, 160)29.3 mmHgStandard Deviation 15
Non-FastingThe Difference in Systolic Blood Pressure Before and After the Month of Ramadan52 weeks (N=1210, 160)30.6 mmHgStandard Deviation 15.9
Secondary

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

ArmMeasureGroupValue (NUMBER)
All SubjectsThe Overall Assessment of Treatment by Patients at 52 WeeksOutstanding25.45 Percentage of participants
All SubjectsThe Overall Assessment of Treatment by Patients at 52 WeeksVery satisfactory53.88 Percentage of participants
All SubjectsThe Overall Assessment of Treatment by Patients at 52 WeeksSatisfactory18.80 Percentage of participants
All SubjectsThe Overall Assessment of Treatment by Patients at 52 WeeksMarginal1.42 Percentage of participants
All SubjectsThe Overall Assessment of Treatment by Patients at 52 WeeksNot satisfactory0.45 Percentage of participants
Secondary

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

ArmMeasureGroupValue (NUMBER)
All SubjectsThe Overall Assessment of Treatment by Physicians at 52 WeeksOutstanding25.97 Percentage of participants
All SubjectsThe Overall Assessment of Treatment by Physicians at 52 WeeksVery satisfactory55.49 Percentage of participants
All SubjectsThe Overall Assessment of Treatment by Physicians at 52 WeeksSatisfactory16.21 Percentage of participants
All SubjectsThe Overall Assessment of Treatment by Physicians at 52 WeeksMarginal1.74 Percentage of participants
All SubjectsThe Overall Assessment of Treatment by Physicians at 52 WeeksNot satisfactory0.58 Percentage of participants
Secondary

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

ArmMeasureGroupValue (NUMBER)
All SubjectsThe Percentage of Patients Achieving JNC 7 Treatment Goals at the End of the 1 Year Treatment DurationYes85.93 Percentage of participants
All SubjectsThe Percentage of Patients Achieving JNC 7 Treatment Goals at the End of the 1 Year Treatment DurationNo14.07 Percentage of participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026