Hypertension
Conditions
Brief summary
Rationale: Diagnosis of endocrine forms of hypertension (primary aldosteronism, pheochromocytoma/paraganglioma and Cushing syndrome) is a lengthy and tedious process. Recently a multiomics biomarker was developed through machine learning that shows high accuracy in predicting the presence of endocrine hypertension or primary hypertension. Given the propensity to data shift in applications of machine learning derived algorithms validation of this multiomics biomarker in a prospective comparative trial is warranted. Objective: To determine the diagnostic performance of the new diagnostic biomarker Study design: A randomized, diagnostic, outcome-based trial Study population: Hypertensive patients 18-75 yrs, referred to ESH Hypertension Excellence centers, who may suffer from endocrine hypertension. Intervention (if applicable): One group is diagnosed by classic endocrine tests, the other by the multiomics biomarker. Ensuing treatment depends on diagnosis and subtyping results. Main study parameters/endpoints: Primary endpoint is potency of antihypertensive medication to reach a target systolic blood pressure value of 135 mm Hg by home blood pressure measurement or an equivalent value for ambulatory blood pressure measurement, standardized office blood pressure measurement or unattended automatic blood pressure measurement. Secondary endpoints: Ambulatory blood pressure, biochemical cure of endocrine hypertension (if treated by surgery), costs, quality of life Nature and extent of the burden and risks associated with participation, benefit and group relatedness: In the control group patients follow the same diagnostic itinerary as in usual care. In the biomarker group, endocrine tests will have been replaced by a blood and urine collection. The risk in both arms consists of missing an endocrine diagnosis. From the preceding accuracy study this risk is low for the use of the biomarker. After 6 months follow-up patients that were diagnosed by the biomarker may switch to a classic analysis.
Interventions
DIAGNOSTIC_TESTHT-ENDO-MOS-A13
Mutli-Omics based biomarker to diagnose primary hypertension or endocrine forms of hypertension; primary aldosteronism, pheochromocytoma/functional paraganglioma or Cushing syndrome.
OTHERNormal diagnosis
Standard diagnosis for endocrine hypertension
Sponsors
JDeinum
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-75 years * Have a properly documented hypertension by abpm, hbpm, unattended office blood pressure measurement or carefully performed office measurement. * Has a physician who feels an urge to exclude or diagnose EHT for one or more of the following reasons * resistant hypertension AND/OR * hypokalemia, spontaneous or diuretic-induced AND/OR * history or physical examination suggestive of endocrine hypertension * Willingness and ability to give informed consent
Exclusion criteria
* White-coat hypertension * Known renal artery stenosis * Known licorice abuse * Known familial form of endocrine hypertension * Cardiovascular event (myocardial infarction, cerebrovascular event) \< 6 months \[Y/N\] * Hypertensive crisis \< 6 months * eGFR \< 50 ml/min/1,73m2 * Liver failure * Known severe valvular or structural heart disease (excluding left ventricular hypertrophy) * NYHA class III or IV heart failure or known reduced left ventricular function (ejection fraction (EF) \<30%) * EKG demonstrating significant pathology (e.g. myocardial infarction, atrial fibrillation, or any other cardial condition prohibiting start of study medication) * Life expancy \< 1 year * For women, current pregnancy or unprotected intercourse
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Potency of antihypertensive medication | from date of start of treament until end of study evaluation (6 months) | Primary endpoint is potency of antihypertensive medication to reach a target systolic blood pressure value of 135 mm Hg by home blood pressure measurement or an equivalent value for ambulatory blood pressure measurement, standardized office blood pressure measurement or unattended automatic blood pressure measurement. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Biochemical cure of endocrine hypertension (if treated by surgery) | from date of start of treament until end of study evaluation (6 months) | Comparison of effectiveness of biochemical cure of endocrine hypertension (if treated by surgery) As defined by normalisation of aldosterone and renin levels in case of adrenalectomy for aldosterne producing adenoma, normalization of (nor)metanephrine levels after surgery for pheochromocytoma, or normalization of cortisol levels after hypophysectomy or adrenalectomy in Cushing disease/syndrome. |
| Cost | from date of randomization until end of study evaluation (6 months) | Cost-effectiveness comparison between the two diagnostic methods.for a cost-effectiveness analysis we will use the costs of all procedures and the results of the EQ-5D questionnaire. |
| Quality of life EQ-5D (min 00000- max 55555, with 55555 having the best quality of life) | from date of start of treament until end of study evaluation (6 months) | Quality of life comparison between participants in the two arms using the EQ-5D |
| Quality of life SF-36 (36-Item Short Form Health Survey, 0-100 for each scale, lower means worse qulaity of life) | from date of start of treament until end of study evaluation (6 months) | Quality of life comparison between participants in the two arms using the SF-36 |
| Ambulatory blood pressure | from date of start of treament until end of study evaluation (6 months) | Ambulatory blood pressure decrease comparison of the two diagnostic methods |
Other
| Measure | Time frame | Description |
|---|---|---|
| carbon footprints of both arms | from inclusion to end of follow-up (6 months after start of treatment) | comparison of the carbon footprints of both arms |
| EHT after secondary standard analysis | From end of follow-up of trial to initial diagnosis confirmed or not (around 3 months) | number of participants with PHT in the MOMICS-ENDO arm who have EHT after a secondary standard analysis after the end of follow-up. |
| Extra standard analysis | From end of follow-up of trial to initial diagnosis confirmed or not (around 3 months) | proportion of participants diagnosed with PHT in the intervention MOMICS-ENDO arm who choose to undergo a standard analysis after the end of follow-up |
Contacts
Primary ContactSecretary Internal Medicine
Outcome results
None listed