International Registry for Ambulatory Blood Pressure and Arterial Stiffness Telemonitoring

Study Overview
=================
Brief Summary
-----------------
This Registry is an investigator-initiated, international, multicenter, observational, prospective study aiming at: i) evaluating non-invasive 24-h ambulatory blood pressure and arterial stiffness estimates (through 24-h pulse wave analysis) in hypertensive subjects; ii) assessing the changes in estimates following treatment; iii) weighing the impact of 24-h pulse wave analysis on target organ damage and cardiovascular prognosis; iv) assessing the relationship between arterial stiffness, blood pressure absolute level and variability, and prognosis. Approximately 2000 subjects, referred to 20 hypertension clinics for routine diagnostic evaluation and follow-up of hypertension, will be recruited. Data collection will include ambulatory blood pressure monitoring, performed with a device allowing simultaneous non-invasive assessment of blood pressure and arterial stiffness, and clinical data (including cardiovascular outcomes). A web-based telemedicine platform will be used for data collection. Subjects will visit the centers at 6-12 month intervals. First follow-up results are expected to be available in the next 2-years. The results of the Registry will help defining the normalcy thresholds for current and future indices derived from 24-h pulse wave velocity, according to outcome data. They will also provide supporting evidence for the inclusion of such evaluation in recommendations on hypertension management.

Detailed Description
-----------------
The VASOTENS Registry is an international, multicenter, observational, prospective project Actually, it is a large database of ambulatory blood pressure recordings obtained with a non-invasive device, able to determine central blood pressure and various indices of arterial stiffness (mainly pulse wave velocity and augmentation index) over the 24-hours, based on a clinically validated technology of pulse wave analysis of oscillometric blood pressure measurements, integrated in an ambulatory blood pressure monitor. Specifically, this project aims at creating an international network of centers performing ambulatory blood pressure monitoring and arterial stiffness monitoring, in order to evaluate the impact of such estimates on the clinical outcome of hypertensive patients. The results of the data collected at baseline and during regular follow-up of hypertensive patients (up to 2 years) will help to provide evidence on the clinical usefulness of such technologies for the screening and follow-up of the hypertensive patients. The registry will include data from subjects fulfilling the inclusion criteria and whose data are contained in existing databases collected by the participating centers and who are regularly followed-up at the center. New subjects can be enrolled for this project, but they must be submitted to ambulatory blood pressure monitoring because it is required for evaluating their hypertension status, according to current recommendations. Data collection is ensured by a dedicated web-based telemedicine platform, including an electronic case report form (e-CRF). The e-CRF allows collection of patient's clinical data, such as family history, anthropometric data, habits, past and current diseases, therapies, office blood pressure, and laboratory tests, including evaluation of target organ damage. The project does not involve any type of intervention related to the study and the physicians can manage the patients included in the Registry according to the requirements of clinical practice and current guidelines. However, as recommended by current guidelines, each patient has to be followed-up with visits occurring at regular intervals (ideally every 6 months, and not less than once a year). The physicians is also free to use the ambulatory blood pressure data in the clinical management of the patients. At least 30 Hypertension centers are planned to be involved in the project, each one providing at least 100 patients, which have to be followed-up over time. Centers will be selected in different countries, initially in Europe, starting from Italy and Russia. Mandatory criteria of a center to be included in the study are the availability in the facility of a BPLab ambulatory blood pressure monitor, the potential for providing and properly following-up the number of patients required by the protocol, the availability of Internet connection, regular access to the web and human resources to upload ambulatory blood pressure and clinical data.

Official Title
-----------------
International Registry for Ambulatory Blood Pressure and Arterial Stiffness Telemonitoring

Conditions
-----------------
Hypertension

Intervention / Treatment
-----------------
* Device: Ambulatory blood pressure monitoring


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Subjects referred to routine diagnostic evaluation for hypertension or established hypertensive subject ABPM performed for clinical reasons with a BPLab device Valid ambualtory blood pressure recordings (interval between measurements not >30 minutes, at least 70% of expected number of readings, at least 20 valid readings during the day-time and 7 during the night-time) Availability of individual measurements for ambulatory blood pressure monitoring Availability of basic demographic and clinical information Availability of a signed informed consent form Exclusion Criteria: Age <18 years Atrial fibrillation, frequent ectopic beats, second or third degree atrioventricular blocks, or other conditions which might make difficult or unreliable the automatic blood pressure measurement with the oscillometric technique Upper arm circumference <22 cm Pregnancy

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Hypertensive patients<br>No intervention. Patients will be sumbitted to standard tests required for hypertension management, including ambulatory blood pressure monitoring, and pharmacologically treated according to recommendations of international guidelines. The registry will include data from subjects fulfilling the inclusion criteria and whose data are contained in existing databases collected by the participating centers and who are regularly followed-up at the center. New subjects can be enrolled for this project, but they must be submitted to ambualtory blood pressure monitoring because it is required for evaluating their hypertension status, according to current recommendations. | Device: Ambulatory blood pressure monitoring<br>* Ambulatory blood pressure monitoring with arterial stiffness evaluation at 6-12 month intervals.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 24-hour Pulse Wave Velocity (PWV) | 24-hour average value for arterial stifness (m/s) | 2 years | 
| 24-hour Augmentation Index (AI) | 24-hour average value for waves reflection (percent) | 2 years | 
| 24-hour Central Blood Pressure | 24-hour average central aortic pressure (mmHg) | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 24-hour Systolic Blood Pressure | Average 24-hour brachial systolic blood pressure (mmHg) | 2 years | 
| 24-hour Diastolic Blood Pressure | Average 24-hour brachial diastolic blood pressure (mmHg) | 2 years | 
| 24-hour Systolic and Diastolic Blood Pressure standard deviation | A measure of blood pressure variability (mmHg) | 2 years | 
| 24-hour Systolic and Diastolic Blood Pressure weighted standard deviation | A measure of blood pressure variability (mmHg) | 2 years | 
| 24-hour Systolic and Diastolic Blood Pressure average real variability | A measure of blood pressure variability (mmHg) | 2 years | 
| Cardiac Damage (left ventricular hypertrophy at echocardiogram or ECG) | Left ventricular hypertrophy indexed by body surface area (g/m^2) | 2 years | 
| Vascular Damage (carotid plaque at ultrasonography) | Intima media tickness (mmm) | 2 years | 
| Renal damage (urine protein) | Urine proteine (mg/24h) | 2 years | 
| Cardiovascular fatal and non fatal events | Cardiovascular outcomes | 2 years | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Hypertension, Arterial Stiffness, Ambulatory blood pressure