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Bedtime versus morning use of antihypertensives for cardiovascular risk reduction (BedMed): protocol for a prospective, randomised, open-label, blinded end-point pragmatic trial.
Garrison, Scott R; Kolber, Michael R; Allan, G Michael; Bakal, Jeffrey; Green, Lee; Singer, Alexander; Trueman, Darryl R; McAlister, Finlay A; Padwal, Raj S; Hill, Michael D; Manns, Braden; McGrail, Kimberlyn; O'Neill, Braden; Greiver, Michelle; Froentjes, Liesbeth S; Manca, Donna P; Mangin, Dee; Wong, Sabrina T; MacLean, Cathy; Kirkwood, Jessica Em; McCracken, Rita; McCormack, James P; Norris, Colleen; Korownyk, Tina.
  • Garrison SR; Family Medicine, University of Alberta, Edmonton, Alberta, Canada scott.garrison@ualberta.ca.
  • Kolber MR; Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
  • Allan GM; Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
  • Bakal J; Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada.
  • Green L; Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
  • Singer A; Family Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada.
  • Trueman DR; BedMed Patient Working Group, Edmonton, Alberta, Canada.
  • McAlister FA; Medicine, University of Alberta, Edmonton, Alberta, Canada.
  • Padwal RS; Medicine, University of Alberta, Edmonton, Alberta, Canada.
  • Hill MD; Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
  • Manns B; Nephrology, University of Calgary, Calgary, Alberta, Canada.
  • McGrail K; Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.
  • O'Neill B; Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Greiver M; Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Froentjes LS; Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
  • Manca DP; Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
  • Mangin D; Family Medicine, McMaster University, Hamilton, Ontario, Canada.
  • Wong ST; Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.
  • MacLean C; Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
  • Kirkwood JE; Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
  • McCracken R; Family Medicine, Providence Health Care, Vancouver, British Columbia, Canada.
  • McCormack JP; Family Practice, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.
  • Norris C; Faculty of Pharmaceutical Science, University of British Columbia, Vancouver, British Columbia, Canada.
  • Korownyk T; Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
BMJ Open ; 12(2): e059711, 2022 Feb 24.
Article in English | MEDLINE | ID: covidwho-1807416
ABSTRACT

INTRODUCTION:

Sleep-time blood pressure correlates more strongly with adverse cardiovascular events than does daytime blood pressure. The BedMed trial evaluates whether bedtime antihypertensive administration, as compared with conventional morning use, reduces major adverse cardiovascular events. METHODS AND

ANALYSIS:

DesignProspective randomised, open-label, blinded end-point trial.ParticipantsHypertensive primary care patients using blood pressure lowering medication and free from glaucoma.SettingCommunity primary care providers in 5 Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba and Ontario) are mailing invitations to their eligible patients. Social media campaigns (Google, Facebook) are additionally running in the same provinces.InterventionConsenting participants are allocated via central randomisation to bedtime vs morning use of all antihypertensives.Follow-up(1) Telephone or email questionnaire at 1 week, 6 weeks, 6 months and every 6 months thereafter, and (2) accessing linked governmental healthcare databases tracking hospital and community medical services.Primary outcomeComposite of all-cause death, or hospitalisation for myocardial infarction/acute-coronary syndrome, stroke or congestive heart failure.Secondary outcomesEach primary outcome element on its own, all-cause hospitalisation or emergency department visit, long-term care admission, non-vertebral fracture, new glaucoma diagnosis, 18-month cognitive decline from baseline (via Short Blessed Test).Select other outcomesSelf-reported nocturia burden at 6 weeks and 6 months (no, minor or major burden), 1-year self-reported overall health score (EQ-5D-5L), self-reported falls, total cost of care (acute and community over study duration) and mean sleep-time systolic blood pressure after 6 months (via 24-hour monitor in a subset of 302 sequential participants).Primary outcome analysisCox proportional hazards survival analysis.Sample sizeThe trial will continue until a projected 254 primary outcome events have occurred.Current statusEnrolment ongoing (3227 randomised to date). ETHICS AND DISSEMINATION BedMed has ethics approval from six research ethics review boards and will publish results in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02990663.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Cardiovascular Diseases / Glaucoma Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Country/Region as subject: North America Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2021-059711

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cardiovascular Diseases / Glaucoma Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Country/Region as subject: North America Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2021-059711