Understanding nighttime blood pressure patterns in hypertension

Non-dipping Hypertension and the Human Chronobiome

This study is trying to see how nighttime blood pressure patterns work in people with high blood pressure to find ways to help them manage it better.

Quick facts

• Study type: Observational
• Enrollment: 150 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: University of Pennsylvania (Academic / other)
• Locations: 1 site (Philadelphia, Pennsylvania)
• Trial ID: NCT03598894 on ClinicalTrials.gov

What this trial studies

This observational study aims to assess the stability of the non-dipping phenotype in patients with hypertension, where blood pressure fails to dip at night. Participants will undergo repeated ambulatory blood pressure measurements to evaluate their 24-hour blood pressure patterns. The study focuses on individuals with a specific daytime systolic blood pressure threshold and a defined difference between daytime and nighttime readings. By understanding these patterns, the study seeks to identify potential clinical benefits of improved blood pressure control.

Who should consider this trial

Good fit: Ideal candidates for this study are adults over 18 years old with a history of hypertension and specific blood pressure measurement criteria.

Not a fit: Patients with severe psychiatric conditions, significant sleep disorders, or other specified health issues may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could lead to better management strategies for patients with hypertension, particularly those with nocturnal non-dipping patterns.

How similar studies have performed: Previous studies have shown that managing blood pressure patterns can lead to significant health improvements, indicating potential success for this approach.

Eligibility criteria

Phase 1: Inclusion Criteria (Stability of the non-dipping phenotype)

1. \>18 years of age,
2. Upper arm with intact skin, i.e. without areas of breached or injured skin visible, for ABP measurements,
3. 24h mean wake SBP \>145mmHg at baseline from 24hr-ABPM readings within the past 12 months,
4. Decline of \<10% between mean day time and night time systolic pressures quantified per 24hr-ABPM within the past 6 months,
5. Own a smartphone.

Phase 1: Exclusion Criteria (Stability of the non-dipping phenotype)

1. Known history of severe psychiatric or cognitive conditions, for example mania, schizophrenia, or mental retardation.
2. Shift work, defined as recurring work between 22:00-05:00,
3. History of clinically significant obstructive sleep apnea;
4. Urine creatinine \> 1.5 mg/dl in men or \>1.3 mg/del in women,
5. Significant liver disease (\>3x upper limit of normal),
6. Diabetes mellitus,
7. Transmeridian travel across ≥2 time zones in the month prior to ABP sessions,
8. Planned transmeridian travel across more than ≥2 time zones during the planned study activities;
9. \> 2 drinks of alcohol per day;
10. Use of illicit drugs which affect blood pressure;
11. Use of pacemaker or implantable Cardioverter Defibrillator, (ICD);
12. Bilateral mastectomy;
13. Hypotension, defined as 90/60 mmHg assessed during the screening visit from ≥ 3 in-office measurements initiated after 10 minutes in seated upright position with 5 minute intervals between measurements;
14. History of Raynaud's phenomenon;
15. Known allergy against natural latex rubber (contained in ABP bladder and tubing);
16. Nursing or pregnant females.

Phase 2: Inclusion Criteria (Deeply phenotyping non-dipping hypertensives)

Inclusion Cohort 1 (case): non-dipping hypertensives 'NDHT'

1. \>18 years of age,
2. Upper arm with intact skin, i.e. without areas of breached or injured skin visible, for ABP measurements,
3. 24h mean wake SBP \>145mmHg from 24hr-ABPM readings confirmed per data base query within the past 12 months prior to enrollment into Phase 1 and across two subsequent 24hr-ABP sessions during Phase 1,
4. Decline of \<10% between mean day time and night time systolic pressures from 24hr-ABPM readings confirmed per data base query within the past 12 months prior to enrollment into Phase 1 and across two subsequent 24hr-ABP sessions during Phase 1,
5. Own a smartphone.

Inclusion Cohort 2 (control): matched healthy normotensives 'NT'

1. \>18 years of age,
2. Upper arm with intact skin, i.e. without areas of breached or injured skin visible, for ABP measurements,
3. Healthy (as assessed by health history, physical exam and screening lab work),
4. 24h mean wake SBP \<130mmHg quantified per 24hr-ABPM,
5. Own a smartphone. 4.3.3 Inclusion Cohort 3 (control): matched dipping hypertensives 'DHT'

1) \>18 years of age, 2) Upper arm with intact skin, i.e. without areas of breached or injured skin visible, for ABP measurements,

1. 24h mean wake SBP \>145mmHg from 24hr-ABPM readings,
2. Decline of \>10% between mean day time and night time systolic pressures from 24hr-ABPM readings,
3. Own a smartphone.

Phase 2 - Exclusion Criteria Cohorts 1-3

1. History of severe psychiatric illness or cognitive conditions, for example ( mania, schizophrenia, or mental retardation;
2. Shift work, defined as recurring work between 22:00-05:00;
3. Clinically significant obstructive sleep apnea as assessed per WatchPAT device;
4. Urine creatinine \> 1.5 mg/dl in men or \>1.3 mg/del in women;
5. Significant liver disease (\>3x upper limit of normal);
6. Diabetes mellitus;
7. Past diagnosis of gastroesophageal reflux disease,
8. Transmeridian travel across ≥2 time zones in the two weeks before the 48hr deep phenotype sessions;
9. Frequent transmeridian flyer (≥2 flights per month) across more than ≥2 time zones during the 12 months of study activities;
10. Use of oral or intravenous antibiotics in the 6 months prior to enrollment;
11. Any contraindication listed below in the separate paragraph "Contraindications for the use of CorTemp® Disposable Temperature Sensors";
12. Subjects, who have received an experimental drug, used an experimental medical device within 30 days prior to screening, or who gave a blood donation of ≥ one pint within 8 weeks prior to screening;
13. \> 2 drinks of alcohol per day;
14. Use of illicit drugs which affect blood pressure;
15. Nursing or pregnant (pregnancy will be repeatedly assessed at the beginning of each of the four inpatient visits, i.e. prior to the start of blood draws);
16. Use of pacemaker or implantable Cardioverter Defibrillator, (ICD)
17. Bilateral mastectomy;
18. Hypotension, defined as 90/60 mmHg assessed during the screening visit from ≥ 3 in-office measurements initiated after 10 minutes in seated upright position with 5 minute intervals between measurements;
19. History of Raynaud's phenomenon;
20. Known allergy against natural latex rubber (contained in ABP bladder and tubing);
21. Subjects taking medication with alpha-blockers;
22. History of clinically significant arrhythmias;
23. Subjects with a history of being particularly susceptible to vomiting or nausea;
24. BMI ≥ 30;
25. History of any type of GI Surgery.

Where this trial is running

Philadelphia, Pennsylvania

• Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania — Philadelphia, Pennsylvania, United States (Recruiting)

Study contacts

• Principal investigator: Garret FitzGerald, MD — University of Pennsylvania
• Study coordinator: LaVenia Banas, CRN

Conditions Hypertension