Impact of Sleep-Disordered Breathing Management in Systemic Hypertension Control: METASLEEP Project
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 1,523
- 试验地点
- 1
- 主要终点
- Changes in nocturnal blood pressure
研究概览
简要总结
Hypertension is a frequent condition affecting 11M Spanish citizens and is the leading modifiable contributor to cardiovascular disease and death. Our society has already identified balanced diet, physical activity and emotional wellbeing as the 3 pillars of healthy living. Healthy sleep should be incorporated as the fourth pillar, as clearly supported by the extensively available scientific evidence. Targeting sleep is considered the new frontier in cardiovascular prevention. In fact, recent scientific evidence encourages consideration of including sleep disturbances in the top 10 potentially modifiable cardiovascular risk factors. Sleep-disordered breathing affect 30-80% of patients with hypertension. The personalized management of hypertension is challenging due to; i) the misclassification of hypertensive patients (affecting 1 out of 3 patients); ii) the lack of adequate treatment of high mortality risk hypertensive phenotypes today is an unmet clinical need; iii) unawareness of the impact of sleep-disordered breathing as a modifiable risk factor for hypertension. Importantly, the investigators already made the seminal observations showing that the treatment for sleep-disordered breathing reduces blood pressure in the hypertensive phenotypes with the highest mortality risk. Given the need for novel strategies to treat hypertension and, supported by our data, the investigators propose to study and treat sleep-disordered breathing to improve hypertension control. METASLEEP will go beyond current state-of the-art providing a new paradigm for the accurate hypertension classification and treatment. This project will open up a new avenue on the therapeutic potential of the management of sleep-disordered breathing in hypertension.
详细描述
This project aims to implement a new hypertension management system, which will include the monitoring and treatment of respiratory disorders during sleep. This new precision medicine-based management will be carried out in the Primary Care setting and will improve blood pressure control, the main risk factor for the leading cause of death worldwide: cardiovascular diseases.
The current model for managing patients with essential hypertension is based on deciding when to treat with measures that go beyond dietary and lifestyle interventions. Once it is decided to treat the patient pharmacologically, the ideal drug is decided and during follow-up whether it is necessary to change the treatment or not. This entire process is usually carried out by the Primary Care doctors. The hypertension specialist is usually reserved for difficult-to-control cases or patients with resistant hypertension. In the current model there is little communication between the different levels of care. In addition, the study of the SDB is carried out completely independently of this process. The METASLEEP project aims to change this work dynamic. The creation of the METASLEEP PC-node centralizes care for patients with hypertension in the Primary Care team (physician and nurse). The PC-node will evaluate the patient comprehensively, incorporating 24-hour ambulatory blood pressure monitoring as well as a sleep study. There will be coordination with the hypertension specialist for the management of complex cases and with the sleep unit specialist to support therapeutic decisions or management of patients with complex sleep apnea. Moreover, our project aims to incorporate the precision medicine techniques, such as the HIPARCO-score in the clinical management of hypertensive patients. Furthermore, the investigators aim to identify the best option that guarantees the best control in different clinical situations, with the greatest anticipation and with the fewest side effects, as well as with the greatest additional benefits and, finally, when to modify the treatment.
The METASLEEP project aims to contribute to the development of personalized medicine tools by identifying the molecular profile that enables to develop a non-invasive model with clinical utility. This model will contribute to the characterization of the patient that is vulnerable to the deleterious effects of OSA and who would benefit from OSA treatment to improve cardiovascular morbidity. The availability of an instrument based on a biomarker profile for risk stratification will help the physician to make therapeutic decisions in individuals with OSA and hypertension, contributing to the change of the current clinical management guidelines. Likewise, molecular tools can be developed to identify the profile of the patient that positively respond to CPAP treatment (in terms of blood pressure decrease). Finally, the investigators will obtain data that will evaluate the economic impact of the METASLEEP project. This cost-effectiveness analysis will be carried out from the perspectives of both, the SNS and the social perspective. Importantly, the investigators have planned a specific objective to define and calculate quantitatively, qualitative and cost-effectively the METASLEEP project, compared to the conventional current procedure.
The overall objective of the METASLEEP project is to establish a new paradigm in the treatment of hypertension through the management of sleep disordered breathing (SDB).
The specific objectives, are the following:
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients with arterial hypertension who visit their primary care physician in one of the participating primary care centers.
- •Signature of the informed consent.
排除标准
- •Psycho-physical inability to complete questionnaires.
- •Patients with very limiting chronic disease.
- •Previous diagnosis of OSA or any other sleeping disorder
- •Active treatment with CPAP.
- •Fixed night shift worker.
结局指标
主要结局
Changes in nocturnal blood pressure
时间窗: At 6 and 18 months
Change in nocturnal blood pressure at 6 and 18 months with respect to baseline (mean night-time)
次要结局
- Validation the HIPARCO-Score tool in an independent cohort, men with resistant hypertension, OSA and CPAP compliance (≥4h/night)(2 years)
- Validation of the METASLEEP score(2 years)
- CPAP compliance at 6 and 18 months(6 and 18 months)
- Satisfaction at 6 and 18 months(6 and 18 months)
- Identification of circulating miRNAs in patients with nocturnal hypertension and sleep disordered breathing.(6 and 18 months)
- Cost-Effectiveness analyses between study groups and to compare the cost of health care utilization between two year before and after the starting of the study related to the study groups.(After 18 months of follow-up)
- Clinic phenotype characterization(6 months)
- Epigenetic, proteomic and metabolomic/lipidomic phenotype characterization(6 and 18 months)
- Changes induced by exosomes(6 months)
- Creation of a predictive tool (like HIPARCO-Score) for women(2 years)
- Changes in Epworth Sleepiness Scale (ESS)(6 and 18 months)
- Changes in Quality of life: Test EuroQol(6 and 18 months)
研究者
Ferran Barbe
Chair Respiratory Medicine
Sociedad Española de Neumología y Cirugía Torácica