Hypertension Clinical Trial
Official title:
Morbidity and Mortality Based on Blood Pressure and Arterial Stiffness in Institutionalized Persons Aged 80 and Over: Study PARTAGE (Predictive Values of Blood Pressure and Arterial Stiffness in Institutionalized Very Aged Population).
Introduction: High blood pressure especially systolic hypertension is a common condition in
the elderly and is considered as a major determinant not only of cardiovascular (CV)
morbidity and mortality, but also of several other age-related diseases, frailty and loss of
autonomy. Actually, the association between BP levels and morbidity and mortality in the
very elderly persons with several co-morbidities remains a controversial issue
Objectives: The aim of the PARTAGE study (Predictive values of blood pressure and arterial
stiffness in institutionalized very aged population)is to determine the predictive value of
blood pressure (BP) and arterial stiffness for overall mortality, major cardiovascular
events and cognitive decline in a large population of institutionalized subjects aged 80 and
over.
Methods: The population is composed of 1130 subjects aged over 80, living in nursing home,
included by four french university hospitals centre (Nancy, Dijon, Paris, Toulouse) and two
Italian (Cesena, Verona). Subjects with severe dementia and a very low level of autonomy are
excluded from the study During the first visit, blood pressure were measured using an
automatic monitor by physician in sitting and standing position (clinical BP and Orthostatic
BP) and by a self measurement of blood pressure 3 measurements, in the morning and the
evening, during 3 consecutive days).
Arterial stiffness is evaluated by measuring the carotid-femoral and carotid-radial pulse
wave velocity (PWV) with the PulsePen® automatic device. Deaths and cardiovascular events
are recorded during a follow-up of 2 years.
The hypothesis of the PARTAGE longitudinal study is that in very elderly frail individuals
with multiple co-morbidities, CV risk could be better evaluated by combining
self-measurements of BP and direct evaluation of arterial stiffness which are less
influenced by the above mentioned disease and co-morbidities.
The aim of PARTAGE study (Predictive values of blood pressure and arterial stiffness in
institutionalized very aged population) is to determine the predictive value of blood
pressure (BP) and arterial stiffness estimated by pulse wave velocity (PWV) on overall
mortality, major CV events and cognitive decline in a large population of subjects living in
nursing homes aged 80 and over.
Method:
Participants are included if they are aged 80 year old and over, are institutionalized and
if they have signed the informed consent.
Persons are excluded if they have severe dementia (Mini Mental Status Examination: MMSE<12),
a low level of autonomy (Activity of daily living: ADL≤2) and they are under guardianship or
"a measure of legal protection".
All geriatric assessment instruments and arterial measures are applied by several trained
medical research teams (geriatricians, cardiologists, psychologists) present at each
university hospitals centre. All medical teams received the same standard operating
procedures. All the assessments are performed in the nursing homes.
Clinical data collection During the first visit in the nursing home, the medical research
team collect a large amount of information during a face-to-face interview and from
patient's medical records. Following information are recorded for each participant in a case
report form (CRF): sociodemographic characteristics, educational level, medical history,
chronic diseases (cardio vascular, central nervous system, respiratory), depressive
symptoms, history of falls, co morbidity and medication use.
Additionally, a clinical examination of functional status, cognitive function, blood
pressure and arterial stiffness are realized by medical research teams.
- Comorbidities are quantified using the Charlson combined comorbidity index.
- Functional status is evaluated by the Katz Index of independence in ability in
activities of daily living (ADL) (bathing, dressing, going to the toilet, transferring
from bed to chair, continence and feeding).
- Cognitive status was assessed using the Mini-Mental-Status-Examination (MMSE), which is
a global measurement of cognitive function evaluating various dimensions of cognition
(memory, calculation, orientation in space and time, language, and word recognition).
Peripheral blood pressure measurements:
Peripheral BP and heart rate (HR) are performed at brachial artery level using the validated
automated oscillometric device Colson DM-H20 (Dupont Médical, Frouard, France). Both
clinical and self-measurement of blood pressure are performed in this study.
- Clinical BP measurements are performed in the morning (from 8 am to noon), by doctors
or nurses, in the patient's room or in the infirmary of the institute, after 10 minutes
rest. All measurements are repeated three times, with intervals of 3 min on the left
arm in a sitting position without replacing the cuff between the three measurements,
according to the specific recommendations of the European Society of Hypertension.
- Self-measurements of BP are performed following the rule of 3 (3 measurements morning
and evening during 3 consecutive days) according to the protocol proposed by the French
society of hypertension. Self-measurements are performed by the subject her/himself in
the room where he/she lives habitually. In case of difficulty, measurement are realized
with the assistance of the nurse of the medical research team or of the institution.
Central blood pressure measurement Central BP values and aortic pressure waveform are
obtained from the common carotid waveform using applanation tonometry. The PulsePen device
(DiaTecne srl, Milan, Italy), a validated, easy to use, high-fidelity tonometer is used.
Pulse wave velocity PulsePen device is also used to measuring carotid-radial pulse wave
velocity (PWV) which reflects upper limb arterial stiffness and carotid-femoral PWV
corresponding to the aortic stiffness.
Follow-up data:
Medical research teams record every 3 months during a follow-up of 2 years deaths and
following cardiovascular events: stroke, transient ischemic attack, myocardial infarction,
unstable angina, acute pulmonary oedema, aortic aneurysm rupture, peripheral arterial
thromboembolism, venous thrombosis and other major cardiovascular event. Moreover, a new
assessment of autonomy, by ADL, and cognitive functions, by MMSE, are achieved in the cohort
by the research teams one year and two year after the first visit.
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Observational Model: Cohort, Time Perspective: Prospective
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