The ACHIEVE Trial: Achieving Longer Gestation in Preeclampsia Via Antihypertensive Therapy.
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 132
- 试验地点
- 2
- 主要终点
- Mean number of days from randomization to delivery
研究概览
简要总结
The Achieve Trial is a randomized clinical trial to test whether lowering blood pressure to less than 140/90 mmHg in women with hypertensive disorders of pregnancy will prolong pregnancy.
详细描述
Hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, are characterized by new onset high blood pressure in pregnancy and constitute a major cause of maternal and perinatal morbidity and mortality; severe hypertension (blood pressure ≥160/110 mmHg) is a common trigger for antihypertensive treatment and preterm delivery. We propose a clinical trial that will test whether lowering the blood pressure in women with hypertensive disorders of pregnancy at <36 weeks' gestation to <140/90 mmHg will prolong pregnancy and, therefore, improve maternal and fetal/neonatal outcomes. Data generated in this study, along with knowledge and skills acquired by the candidate in the complementary career development plan, will facilitate an independent research career focused on hypertension and cardiovascular disease in pregnancy.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 14 Years 至 49 Years（Child, Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Pregnant women
- •Gestational age: 23 weeks, 0 days to 35 weeks, 6 days
- •Hypertensive disorder of pregnancy including gestational hypertension or preeclampsia, the non-severe form at enrollment, which is called without severe features by the American College of Obstetricians and Gynecologists.
- •No evidence of the severe form of preeclampsia, termed severe features, as outlined in maternal exclusions
- •No indication for delivery at the time of enrollment.
- •Planned expectant management at time of enrollment
- •Singleton or dichorionic twin gestation, defined at and beyond 14 weeks gestation. (A pregnancy complicated by a vanishing twin in the first trimester defined as less than 14 weeks gestation will be eligible.)
- •Intact membranes
排除标准
- •Preeclampsia with severe features, defined per ACOG as:
- •Systolic blood pressure of 160 mm Hg or more, or diastolic blood pressure of 110 mm Hg or more on two occasions at least 4 hours apart (unless antihypertensive therapy is initiated before this time)
- •Thrombocytopenia defined as: lower than 100 x 10e9 platelets/L
- •Impaired liver function that is not accounted for by alternative diagnoses and as indicated by abnormally elevated blood concentrations of liver enzymes (to more than twice the upper limit normal concentrations), or by severe persistent right upper quadrant or epigastric pain unresponsive to medications
- •Renal insufficiency (serum creatinine concentration more than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease)
- •Pulmonary edema
- •New-onset headache unresponsive to medication and not accounted for by alternative diagnoses
- •Visual disturbances
- •Underlying renal dysfunction defined as, presenting the following parameters prior to 20 weeks gestation: baseline creatinine, equal to or higher than, 1.2 mg/dL Or proteinuria: defined as presenting protein in urine, equal to or higher than, 300 mg/24 hours or protein/creatinine ratio, equal to or higher than, 0.3 or Urine dipstick reading of greater than or equal to 2 at baseline and in the absence of a urinary tract infection
- •Stage 2 chronic hypertension
- •Contraindications to labetalol and nifedipine XL according to the FDA package insert
- •Patient unable to or unwilling to adhere to management recommendations
- •Fetal Reasons for Study Ineligibility:
- •Fetal growth restriction (lower than 10th percentile) at enrollment, based on an ultrasound within 3 weeks prior to enrollment
- •Oligohydramnios defined by amniotic fluid deepest vertical pocket <2 cm based on an ultrasound within the 48 hours prior to enrollment
- •Known major structural or chromosomal abnormality
研究组 & 干预措施
Intervention
Antihypertensive treatment for a BP goal of less than 140/90 mmHg
干预措施: Antihypertensive treatment (Drug)
结局指标
主要结局
Mean number of days from randomization to delivery
时间窗: From randomization to delivery, up to 14 weeks
Duration of prolongation of pregnancy
次要结局
- Perinatal morbidity(6 weeks)
- Neonatal healthcare utilization(6 weeks)
- Maternal morbidity(From randomization to 6 weeks after delivery, up to 20 weeks)
- Maternal healthcare utilization(From randomization to 6 weeks after delivery, up to 20 weeks)
研究者
Rachel Sinkey
Assistant Professor
University of Alabama at Birmingham