Strategy for Preventing Cardiovascular and Renal Events Based on ARTErial Stiffness

Study Overview
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Brief Summary
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Randomised two parallel groups multicenter study using a Prospective Randomised Open Blinded End-point design (PROBE), aiming at comparing the efficacy of a therapeutic strategy targeting the normalisation of arterial stiffness for reducing cardiovascular (CV) and renal events, in comparison with a classical therapeutic strategy implementing the European Society of Hypertension-European Society of Cardiology (ESH-ESC) Guidelines, in patients with essential hypertension and medium-to-very high CV risk.

Detailed Description
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The objective is to show that a therapeutic strategy targeting the implementation of international guidelines PLUS the normalisation of blood pression (BP < 140 and 90 mmHg) plus the normalisation of arterial stiffness (measured every 6 months) Pulse Wave Velocity group (PWV group) reduces CV and renal events to a significantly greater extent than the sole implementation of Guidelines (conventional group, with PWV measurement at baseline and every 2 years). Experimental design: Prospective Randomised Open Blinded Endpoint (PROBE) multicenter, two parallel groups, study. Therapeutic strategy in the PWV group: Use maximal recommended doses of angiotensin-converting-enzyme inhibitor (ACEIs) or Angiotensin II receptor blockers (ARBs) as first step treatment. And then adapt treatment to PWV values. In second step, use combination therapy with Calcium channel blockers (CCBs) Use diuretics in combination therapy, either as an alternative to CCBs in second step or as triple therapy in third step Use, as fourth step, vasodilating beta-blockers (VD-BB) or spironolactone In parallel, correct all CV risk factors according to ESH-ESC Guidelines, and reinforce treatment (hypolipidemic drugs, glucose lowering drugs, antiplatelets) if secondary prevention. Therapeutic strategy in the conventional group: Apply the ESH-ESC Guidelines

Official Title
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Strategy for Preventing Cardiovascular and Renal Events Based on ARTErial Stiffness

Conditions
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Hypertension

Intervention / Treatment
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* Other: Cardiovascular risk management based on PWV


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: registration to the French social security system patients who did not specifically express their non willingness to participate PLUS either A, B or C: Patients with essential hypertension, aged 55 to 75 years old, both sexes Grade 1 hypertension of more Treated or not Whatever the control of BP Under primary of secondary prevention (more than 3 months stroke or myocard infarctus (MI), or stable angina or peripheral artery disease) PLUS at least 3 CV risk factors according to ESH-ESC 2007 guidelines or metabolic syndrome associating at least 2 of the following criteria SBP/DBP over 130/85 mmHg HDL-C <1.0 mmol/l (0,4 g/l) (M) or < 1.2 mmol/l (0,46 g/l) (F) Triglycerides >1,7 mmol/l (>1,5 g/l) Fasting blood glucose 5,6 - 6,9 mmol/l (1,02-1,25 g/l) Waist circumference > 102 cm (M) ou 88 cm (F) or Type 2 diabetes or Target organ damage, according to the definition of the ESH-ESC Guidelines for the Management of Hypertension or CV disease or chronic kidney disease SBP > 180 mmHg and/or DBP > 110 mmHg SBP > 160 mmHg AND DBP < 70 mmHg Exclusion Criteria: Patients with ABPM or self-measurement normal without treatment (<130 mmHg and 80 in the ABPM 24 or <135 and 85 mmHg or daytime ABPM self-measurement of blood pressure) Patients with secondary hypertension (renal artery stenosis, pheochromocytoma, or hypermineralocortisism) Patients with hypertension secondary to diabetic nephropathy Patients aged under 55 or over 75 years, Low-risk CV patients Patients with severe chronic renal impairment creatinine clearance (MDRD) <30ml / min / 1.73m2 Patients with type I diabetes Patients with severe disease threatening the vital prognosis in the short and medium terms Patients who previously experienced a painful gynecomastia under spironolactone Patients with alcohol dependence or excessive consumption alcoholic beverages (at the judgement of the investigator) patients with accident history neurovascular, coronary insufficiency (coronary bypass surgery or percutaneous coronary intervention) not older than 3 month Patients with a history of acute heart failure or having open failure heart (NYHA class III-IV) Patients with unstable angina Auricular Fibrillation (AF) less than 6 months ago Patients with aortic stent Patients with known aneurysms of the abdominal aorta Patients with atrioventricular block second or third degree without pacemaker Patients having received organ transplant or placed on a waiting list for transplantation Patients with severe chronic inflammatory disease (rheumatoid arthritis; lupus; scleroderma ...) Patients with severe chronic infectious disease Patients who have had an MI less than 3 months ago Patients with stroke there are less than 3 months ago Patients with progression of peripheral arterial disease Patient whose pregnancy is known or which has no effective contraception if is of childbearing age, or if she is breastfeeding Patients who have expressed their opposition to participate in the protocol or have an inability to understand or follow the protocol The patients geographically too far from the place of investigation Patients already participating in other drug research protocol or Interventional

Ages Eligible for Study
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Minimum Age: 55 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: PWV group<br>Cardiovascular risk management based on PWV will include altogether the implementation of international guidelines, the normalisation of blood pressure, and the normalisation of arterial stiffness | Other: Cardiovascular risk management based on PWV<br>* Arterial stiffness will be measured through the determination of the carotid-femoral pulse wave velocity (PWV). In the PWV group, PWV will be measured at baseline, and then every 6 months. PWV measurement will guide the intensification of treatment. Measurements will be immediately available to the physician in charge of the patient, in order to adapt treatment. The therapeutic strategy is based both on the normalisation of BP and then on the BP-independent reduction in PWV, using commercially available antihypertensive medications. In the conventional group, PWV will be measured at baseline, after 2 years, and at the end of the study. PWV values will be masked to the physician<br>|
| No Intervention: Conventional group<br>These patients will be treated according to the 2007 (and then 2013) ESH-ESC Guidelines for the management of hypertension | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of cardiovascular and renal events | The primary efficacy outcome variable is defined as the composite endpoint of cardiovascular death, non-fatal myocardial Infarction, non-fatal stroke, adverse renal outcome (defined by chronic dialysis, kidney transplantation, or doubling of serum creatinine) and hospitalization for any of the following causes: angioplasty or bypass surgery for coronary or peripheral vessel disease, congestive heart failure, or aortic dissection. An independent committee will validate the events and causes blinded treatment received | 4 years of follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of non-fatal myocardial Infarction |  | 4 years follow-up | 
| Number of non-fatal stroke |  | 4 years follow-up | 
| Number of adverse renal outcome (defined by chronic dialysis, kidney transplantation, or doubling of serum creatinine) |  | 4 years follow-up | 
| Number of hospitalization for any of the following causes: angioplasty or bypass surgery for coronary or peripheral vessel disease |  | 4 years follow-up | 
| Number of congestive heart failure |  | 4 years follow-up | 
| Number of aortic dissection |  | 4 years follow-up | 
| Carotid-femoral pulse wave velocity (PWV) value at the end of the study |  | 4 years follow-up | 
| Central systolic blood pressure value |  | 4 years follow-up | 
| Central pulse pressure value |  | 4 years follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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arterial stiffness, cardiovascular risk, cardiovascular events, renal events