Plain English Summary
Background and study aims
White coat hypertension is when a patient has raised blood pressure when they are in a clinic setting but normal blood pressure at home. At present, white coat hypertension isn’t treated, but previous research has suggested that there might be some benefit to treating it in relation to conditions affecting the heart and blood vessels. This study is looking at whether it is possible to run a trial to treat white coat hypertension in older patients with blood pressure lowering drugs.
Who can participate?
Patients aged 75 and over with white coat hypertension
What does the study involve?
Participants are randomly allocated to blood pressure lowering treatment for 12 months or no treatment. There are required visits to the GP every 2 months throughout the 12-month period and participants are asked to keep a diary of any ailments that they experience during the study.
What are the possible benefits and risks of participating?
There are no specific benefits to the participant. However, research delivers wider benefits to society and this study may help to improve care for others with a similar condition in the future. Information gathered in this trial will help develop the design and delivery of the full trial.
Where is the study run from?
1. Brockwood Medical Practice (UK)
2. Cossington House Surgery (UK)
3. Furnace Green Surgery (UK)
4. Henfield Medical Centre (UK)
5. Mid Sussex Healthcare (UK)
6. Newton Place Surgery (UK)
7. Northbourne Medical Centre (UK)
8. Park Road Surgery (UK)
9. Stone Cross Surgery (UK)
10. Trinity Medical Centre (UK)
11. Woodbridge Hill Surgery (UK)
When is the study starting and how long is it expected to run for?
April 2018 to April 2021
Who is funding the study?
Dunhill Medical Trust (UK)
Who is the main contact?
Dr Colin McAlister
bsctu@bsms.ac.uk
Trial website
Contact information
Type
Scientific
Primary contact
Dr Colin McAlister
ORCID ID
Contact details
Brighton & Sussex Clinical Trials Unit
Room 204 Bevendean House
University of Brighton
Falmer
BN1 9PH
United Kingdom
+44 (0)1273 641445
bsctu@bsms.ac.uk
Additional identifiers
EudraCT number
2017-004004-22
ClinicalTrials.gov number
Protocol/serial number
37147
Study information
Scientific title
A multi-centred, open label, randomised study assessing the cardiovascular outcomes following treatment of white coat hypertension with established anti-hypertensive drugs versus standard of care in the very elderly - feasibility study
Acronym
HYVET 2
Study hypothesis
The HYVET 2 study is looking at whether it is possible to treat White Coat Hypertension in older patients with blood pressure lowering drugs. White Coat Hypertension is a raised blood pressure when you are in a clinic setting however, your blood pressure at home is normal. At present, White Coat Hypertension isn’t treated, however, previous research has suggested that there might be some benefit to treating White Coat Hypertension in relation to conditions affecting the heart and blood vessels. We want to investigate this further.
This is a multi-centre, open-label study assessing the feasibility of conducting a randomised controlled trial to treat white coat hypertension in the very elderly.
Ethics approval
London – Westminster REC, 03/04/2018, ref: 18/LO/0104
Study design
Randomised; Interventional; Design type: Treatment, Drug
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
GP practices
Trial type
Treatment
Patient information sheet
Not available in web format, please use the contact details to request a patient information sheet
Condition
Specialty: Primary Care, Primary sub-specialty: Ageing; UKCRC code/ Disease: Cardiovascular/ Hypertensive diseases
Intervention
It will entail a 1:1 randomisation of patients to a treatment arm with established antihypertensive drugs (indapamide and perindopril) and control arm (no treatment) which is current standard of care. This design will gather preliminary information on the intervention and the feasibility of conducting a full-scale randomised controlled trial. Recruitment will take place in GP surgeries.
Once potential participants have been identified through database search and mailouts or opportunistic recruitment, the participant will be invited in to consent for the trial and have a clinic blood pressure measurement. Within the next 2 weeks (+/- 7 days) the participant will return to the GP surgery for cognitive function assessments, review of past & current medical history, review of concomitant medications, another clinic blood pressure measurement, 24 hours ABPM (Ambulatory Blood Pressure Monitoring) and HBPM (Home Blood Pressure Monitoring), routine blood tests (biochemistry and haematology) and a 12 lead ECG. This will constitute the screening visits (visits 1 and 2).
Following visits 1 and 2, at Baseline (Visit 3) which is a further two weeks later +/-7 days) the particpant will be randomised to either the treatment arm or no treatment (current standard of care). An NHS prescription will then be written and given to the participant. Frailty assessments, an assessment of concomitant medications, adverse events, clinic blood pressure and other routine baseline data will be performed.
At Visits 4 and 5 (Weeks 12, 20 +/-7 days) the participant will be expected to return to the GP surgery for a clinic blood pressure measurement, assessment of adverse events and concomitant medications, HBPM, another prescription if required and a pill count of unused tablets or empty packaging.
At Visit 6 (Week 28 +/- 7 days) the participant will be required to return to the GP surgery for review of concomitant medications and adverse events, clinic blood pressure measurement, ABPM, HBPM, routine bloods (biochemistry and haematology), 12 lead ECG, prescription if required and an adherence check (pill count).
At Visits 7 and 8 (Weeks 36 and 44 +/- 7 days) the participant will be expected to come in to the GP surgery for a clinic blood pressure measurement and an assessment of concomitant medications and adverse events.
At Visit 9 (Week 52 +/- 7 days), the participant will be required to return to the GP surgery for cognitive function assessment and frailty assessments, review of concomitant medications and adverse events, clinic blood pressure measurement, HBPM, routine bloods (biochemistry and haematology), 12 lead ECG and an adherence check (pill count).
At Visit 10 (Week 60 +/- 7 days) the participant will be expected to come in to the GP surgery for a clinic blood pressure measurement, an assessment of concomitant medications and adverse events. In addition, 10 participants will be interviewed regarding their experience by members of the Patient and Public Involvement group.
Extra visits might be scheduled by the principal investigator, as appropriate, based on clinical requirement.
Follow up information on all participants will be sought after 2 years from the end of trial participation by reviewing the GP records to determine whether the participant is alive or deceased and whether they have experienced any cardiovascular outcomes.
Intervention type
Drug
Phase
Not Applicable
Drug names
Indapamide, perindopril
Primary outcome measure
HYVET 2 is a feasibility study which will focus on the following outcomes:
1. The estimated proportion of eligible patients that can be recruited from initial screening by reviewing Screening Logs to determine the proportion of screened patients eligible for recruitment on an ongoing basis
2. The effectiveness of different methods of identifying/recruiting patients - search and mail out, opportunistic recruitment and posters/adverts are included in the protocol design
3. The willingness of GPs to recruit and randomise patients, assessed by getting feedback from Primary Care team and GPs directly
4. The willingness of patients to be randomised, assessed by reviewing Screening Logs to determine the proportion of screened patients eligible for recruitment on an ongoing basis
5. The recruitment rate over the trial duration and the proportion of eligible patients that provide consent on an ongoing basis
6. Adherence to the treatment protocol by performing pill counts at each visit
7. The proportion withdrawing and reason for withdrawal, assessed on an ongoing basis
8. The opportunities for PPI (patient and public involvement) in the research design and its subsequent conduct and dissemination. A lay member will sit on the TSC and a PPI panel will review patient facing documents
9. Incidence of cardiovascular events by assessing the composition of cardiovascular events on an ongoing basis
10. Ambulatory and home blood pressure (mmHg) measured on an ongoing basis
Secondary outcome measures
-
Overall trial start date
23/04/2018
Overall trial end date
22/04/2021
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
1. Patients ≥75 years of age
2. Clinic sitting systolic BP ≥150 mmHg but <200 mmHg and diastolic BP <110 mmHg
3. Established diagnosis of white coat hypertension - confirmed if the mean ambulatory day time average systolic BP is <135 mmHg and diastolic BP is <85 mmHg (from at least 14 measurements) or for HBPM from BP readings twice a day for at least 5 days (ideally 7 days) at baseline
4. Not taken antihypertensive drug therapy within the last 6 months
5. Capacity to consent
6. Provision of documented informed consent
7. Ability to comply with the protocol and additional study visits and assessments
Participant type
Patient
Age group
Senior
Gender
Both
Target number of participants
Planned Sample Size: 100; UK Sample Size: 100
Participant exclusion criteria
1. Contraindication to the use of indapamide MR and perindopril in accordance with the summary of product characteristics
2. Regular non-steroidal anti-inflammatory drug (NSAID) use. Regular use being defined by the local GP with consideration to cardiovascular risk and blood pressure
3. Hypertensive emergency
4. Secondary hypertension
5. Postural hypotension (postural drop in systolic BP> = 20 mmHg or postural symptoms at screening)
6. Any stroke or myocardial infarction in the previous 6 months
7. Heart failure requiring treatment with drugs having an antihypertensive effect
8. Previous documented evidence of gout
9. eGFR less than 30ml/min
10. Montreal cognitive assessment score (MoCA) < 22
11. Life expectancy < 1 year due to malignancy or chronic disease
Recruitment start date
16/07/2018
Recruitment end date
15/07/2019
Locations
Countries of recruitment
United Kingdom
Trial participating centre
Brockwood Medical Practice
Brockham Surgery
Tanners Meadow
Brockham
RH3 7NJ
United Kingdom
Trial participating centre
Cossington House Surgery
51 Cossington Road
Canterbury
CT1 3HX
United Kingdom
Trial participating centre
Furnace Green Surgery
50 The Glade
Furnace Green
Crawley
RH10 6JN
United Kingdom
Trial participating centre
Henfield Medical Centre
Deer Park
Henfield
BN5 9JQ
United Kingdom
Trial participating centre
Mid Sussex Healthcare
Hurstpierpoint Health Centre
Mid Sussex Health Care
Trinity Road
Hurstpierpoint
BN6 9UQ
United Kingdom
Trial participating centre
Newton Place Surgery
Newton Road
Faversham
ME13 8FH
United Kingdom
Trial participating centre
Northbourne Medical Centre
193A Upper Shoreham Road
Shoreham-by-Sea
BN43 6BT
United Kingdom
Trial participating centre
Park Road Surgery
143 Park Road
Camberley
GU15 2NN
United Kingdom
Trial participating centre
Stone Cross Surgery
Mimram Road
Stone Cross
BN24 5DZ
United Kingdom
Trial participating centre
Trinity Medical Centre
1 Goldstone Villas
Hove
BN3 3AT
United Kingdom
Trial participating centre
Woodbridge Hill Surgery
1 Deerbarn Road
Guildford
GU2 8YB
United Kingdom
Sponsor information
Organisation
University of Sussex
Sponsor details
c/o Dr Antony Walsh
Research Governance Officer
Research and Enterprise Services
Falmer House
Brighton
BN1 9QF
United Kingdom
+44 (0)1273 872748 Internal Extension: 2748
researchsponsorship@sussex.ac.uk
Sponsor type
University/education
Website
Funders
Funder type
Charity
Funder name
Dunhill Medical Trust; Grant Codes: R541/0217
Alternative name(s)
DMT
Funding Body Type
private sector organisation
Funding Body Subtype
other non-profit
Location
United Kingdom
Results and Publications
Publication and dissemination plan
Planned publication in a high-impact peer reviewed journal.
IPD sharing statement
The data sharing plans for the current study are unknown and will be made available at a later date.
Intention to publish date
22/04/2022
Participant level data
To be made available at a later date
Basic results (scientific)
Publication list