Hypertension Clinical Trial
Official title:
A Pilot Study of N-of-1 Trials of Blood Pressure Medications in Adults With Hypertension
Many patients want to know which blood pressure medication is the best for them. In this study, we will test the feasibility of a new approach to determining the best blood pressure medication for individual patients by performing an N-of-1 trial in which patients will have the opportunity to test a series of 3 blood pressure medications at escalating doses while carefully measuring their blood pressure and side-effects. At the end of each of these N-of-1 trials, we will ask patients to complete a questionnaire in which they rate their level of satisfaction with this approach to learning about which is the best blood pressure medication for them.
The goal of this research is to empower hypertensive patients to learn which blood pressure
(BP) medication is best for them. Although lifestyle factors such as diet and exercise play
an important role, medications may still needed to achieve BP control. Yet, there are
substantial differences in the way BP medications affect patients; medications well-tolerated
in some, cause severe side-effects in others. Similarly, medications that cause larger
reductions in BP in some patients have smaller BP lowering effects in others. Despite this
heterogeneity in treatment effects, there are no proven real-world methods to help patients
identify the medication most suited to their needs.
One potential approach to individualizing BP treatment decisions is to conduct N-of-1 trials:
a multiple crossover design conducted in a single patient. Despite the appeal of this
approach, there are few published reports of BP medication N-of-1 trials. Therefore, the
objective of this study is to determine the feasibility of conducting an N-of-1 BP medication
trial in hypertensive patients. Patients who meet all the eligibility criteria will be asked
to monitor their blood pressure and side-effects while taking a series of commonly prescribed
blood pressure medications. If they are already taking a blood pressure medication, they will
begin by tracking their blood pressure and side-effects while taking this medication for 1
week. They will then be asked to track their blood pressure and side-effects while taking a
series of up to three other blood pressure medications (losartan - a renin-angiotensin system
blocking agent, amlodipine - a calcium channel blocker, and hydrochlorothiazide - a thiazide
diuretic). Each of these medications will be taken for 2 weeks at a time. The specific choice
of medications and medication doses will be selected by the study physician. Unless patients
have side-effects that lead them to discontinue a medication early, patients will be expected
to take each medication at least twice in a balanced sequence (e.g., losartan - amlodipine -
HCTZ - HCTZ - amlodipine - losartan). Patients will measure their blood pressure and
medication side-effects during the 2nd week on each of these medications. Patients will have
the option of escalating or decreasing dosages to identify the single medication/medication
dose that best lowers their blood pressure with the least side-effects. Blood pressure will
be measured using an Omron home blood pressure monitor. Side-effects will be tracked using a
daily e-mailed survey that is completed over the Internet.
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