The Use of Ambulatory Blood Pressure Monitors to Assess Angiotensin Converting Enzyme Inhibitors in Resistant Hypertension
Overview
- Phase
- Phase 1
- Intervention
- Equivalent dose enalapril
- Conditions
- Hypertension, Resistant to Conventional Therapy
- Sponsor
- Memorial Health University Medical Center
- Enrollment
- 20
- Locations
- 1
- Primary Endpoint
- Change from baseline nighttime blood pressure
- Last Updated
- 8 years ago
Overview
Brief Summary
The purpose of this study is to use ambulatory blood pressure monitors to investigate whether enalapril is superior to lisinopril in managing nocturnal hypertension in patients with resistant hypertension currently treated with daytime angiotensin converting enzyme inhibitors.
Detailed Description
Resistant hypertension is defined as blood pressure \> 140/90 mm Hg while adherent to three or more antihypertensive medications or \< 140/90 mm Hg treated with four or more antihypertensives. Patients with resistant hypertension may be at risk for elevated nighttime blood pressure \>120/70 mm Hg and "non-dipping" (night/day blood pressure \> 0.9). A higher rate of cardiovascular events occur during the "morning surge" partially attributed elevated nighttime blood pressure due to increased renin angiotensin aldosterone system (RAAS) activity. Angiotensin converting enzyme inhibitors (ACEIs) suppress RAAS activity This prospective randomized parallel-group pilot study will occur at Memorial Family Medicine. Eligible patients will undergo three study visits over a 5-8 week span. After providing written informed consent, patients will complete an initial screening visit assessing 25 hour blood pressure using ambulatory blood pressure monitors. Patients will continue the study if they are found to have a nighttime blood pressure \>120/70 mm Hg. Patients continuing the study will be randomly assigned to equivalent dose lisinopril or enalapril treatment arms and their administration time will be changed to "bedtime." At the final visit, patients will complete a final ambulatory blood pressure analysis to reassess nighttime blood pressure and dipping status. It's expected that patients with enalapril treatment will have superior nighttime blood pressure reduction compared to the lisinopril treatment group. If the expected outcome occurs, more patients in the enalapril group will meet their nighttime blood pressure goal (\<120/70 mm Hg) and exhibit a "dipping pattern." Current evidence suggests that patients with normal nighttime blood pressure and dipping pattern are at a lower risk for cardiovascular morbidity and mortality.
Investigators
John Bucheit, Pharm.D.,BCACP, CDE
Principal Investigator
Memorial Health University Medical Center
Eligibility Criteria
Inclusion Criteria
- •Patients with clinic blood pressure \> 140/90 mm Hg on 3 antihypertensives or clinic blood pressure \< 140/90 mm Hg on 4 antihypertensives
- •Currently treated with an angiotensin converting enzyme inhibitor
Exclusion Criteria
- •Chronic kidney disease (CKD) stage 4 or worse
- •Pheochromocytoma
- •Unstable cardiovascular disease Stroke, Transient Ischemic Attack, Unstable Angina, or Myocardial infarction in the last 30 days
- •Hyperaldosteronism
- •Current pregnancy
- •Shift worker at night
- •Presenting blood pressure \> 180/110 mm Hg
Arms & Interventions
Enalapril arm
Patients randomized to this group will receive equivalent dose enalapril to their current ACEI therapy and change the administration time to bedtime.
Intervention: Equivalent dose enalapril
Lisinopril arm
Patients randomized to this group will receive equivalent dose lisinopril to their current ACEI therapy and change the administration time to bedtime.
Intervention: Equivalent dose lisinopril
Outcomes
Primary Outcomes
Change from baseline nighttime blood pressure
Time Frame: Baseline and 4-6 weeks
Average blood pressure between 0000-0600.
Secondary Outcomes
- Change from baseline night to day blood pressure ratio (dipping status)(Baseline and 4-6 weeks)
- Change from baseline 24 Hour Blood Pressure(Baseline and 4-6 weeks)