Chronic Kidney Diseases, Hypertension
Conditions
Brief summary
This is a pilot, crossover trial in which the investigator will determine if retiming of one anti-hypertensive medication from morning to evening can effectuate normal blood pressure dipping patterns in children and adolescents with chronic kidney disease.
Detailed description
Normally blood pressure declines by at least 10% from daytime to nighttime. In children with chronic kidney disease (CKD), often this does not happen (termed non-dipping). This study is a pilot, randomized cross-over trial. The main purpose of this study is to investigate whether non-dipping can be modified with retiming of anti-hypertensives in children with CKD. This is important because in adults, non-dipping has been associated with increased cardiovascular disease risk and more rapid progression of kidney disease. Thus, identification of how to modify this in children with CKD, may lead to future randomized controlled trials to evaluate whether chronotherapy improves outcomes in this population, which is at high risk for morbidity and mortality in adulthood. The primary objective of this study is to determine whether retiming of one anti-hypertensive to the evening will increase nocturnal systolic blood pressure change (%) in children with CKD, hypertension and non-dipping. The secondary objective of this study is to determine whether retiming of one anti-hypertensive to the evening will increase nocturnal diastolic blood pressure change (%) in children with CKD, hypertension and non-dipping. Another secondary objective is to determine if the proportion of subjects classified as having a non-dipping pattern is significantly lower on evening dosing of anti-hypertensives.
Interventions
OTHERRe-timing of anti-hypertensive drug
The intervention will consist of shifting the anti-hypertensive medication from morning/early dose to an evening/later dose
OTHERCurrent regimen
The participants will begin on their current regimen.
Sponsors
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
American Heart Association
Yale University
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
6 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Male or female child/adolescent up to 18 years of age with CKD * estimated glomerular filtration rate (eGFR) of 30 to 90 ml/min/1.73 m2 * diagnosed with hypertension and on a stable dose of anti-hypertensive medication(s) for at least 3 months * Non-dipping identified on ABPM
Exclusion criteria
* history of organ transplantation, oncological disease, or dialysis * inability to complete 24-hour ABPM or 24-hour urine collection * Children less than 6 years of age will be excluded, as they often are unable to complete a successful ABPM study (≥ 40 readings, with 1 reading per hour of sleep) * Currently on diuretic medications.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent change in nocturnal systolic blood pressure in participants administered anti-hypertensive medications at night on Ambulatory blood pressure monitor(ing) (ABPM). | Baseline and Month 1 | Percent change in systolic nocturnal blood pressure will be calculated as : (daytime mean SBP - nighttime mean SBP)/daytime mean SBP x 100 to assess if nocturnal BP dipping can be restored. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent change in nocturnal diastolic blood pressure in participants administered anti-hypertensive medications at night on ABPM. | Baseline and Month 1 | Percent change in systolic nocturnal blood pressure will be calculated as: (daytime mean DBP - nighttime mean DBP)/daytime mean DBP x 100 to assess if nocturnal BP dipping can be restored. |
| Change in proportion of participants with restoration of dipping while on the intervention, defined as <10% systolic or diastolic nocturnal blood pressure change | Baseline and Month 1 | This outcome will assess if the proportion of subjects classified as having a non-dipping pattern is significantly lower on evening dosing of anti-hypertensives. Restoration of dipping would mean that both systolic and diastolic nocturnal blood pressure change are greater than or equal to 10%, after the intervention. |
Countries
United States
Outcome results
None listed