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Multi-center cluster-randomised clinical trial to evaluate the efficacy of an intervention to improve anti-hypertensive medication adherence among patients with uncontrolled hypertension and high cardiovascular risk
ISRCTN ISRCTN35208258
DOI 10.1186/ISRCTN35208258
ClinicalTrials.gov identifier
EudraCT number
Public title Multi-center cluster-randomised clinical trial to evaluate the efficacy of an intervention to improve anti-hypertensive medication adherence among patients with uncontrolled hypertension and high cardiovascular risk
Scientific title
Acronym COM 99
Serial number at source N/A
Study hypothesis Added as of 01/12/2008:
The proposed study intervention to improve adherence to antihypertensive medication will improve both adherence to antihypertensive medication and the degree of blood pressure control. The better blood pressure control in the intervention group will result in a reduction of cardiovascular events.

Please note that, as of 01/12/2008, the start and end dates of this trial have been updated from 10/04/2000 and 05/05/2002 to 01/01/2000 and 01/12/2005, respectively.
Lay summary
Ethics approval Institutional Review Board of the Hospital General de Vic (Spain), approved on 02/06/1999.
Study design Randomised controlled trial
Countries of recruitment Spain
Disease/condition/study domain Arterial hypertension
Participants - inclusion criteria 900 patients, aged 50 or older, presenting non-controlled systolic and/or diastolic hypertension, elevated cardiovascular risk (ten-year probability of a cardiovascular event ≥30%).
90 physicians from hospitals and primary care centers will be randomly allocated to the intervention or control group.
Participants - exclusion criteria 1. Participation in any investigational clinical trial within the past 3 months.
2. Incapacity or unwillingness to sign the informed consent.
Anticipated start date 01/01/2000
Anticipated end date 01/12/2005
Status of trial Completed
Patient information material
Target number of participants 900
Interventions Usual clinical practice will be continued in patients assigned to the control group. The intervention to improve adherence to antihypertensive medications in the treatment group will include multi-level components (behavioral, cognitive, and social support). The clinical guidelines published by the World Health Organization (WHO) and the International Society of Hypertension (ISH) will be used to classify patients by their cardiovascular risk. The trial will be actively monitored to perform quality data assurance as well as external auditing.
Outcomes: Adherence to medications will be measured in both the control and intervention group using an electronically monitored pill container (EDEM®), which registers the date and time a pill is removed from the container. Blood pressure will be registered at each visit with a validated semiautomatic
sphygmomanometer (OMRON 705-CP). Primary outcomes will include blood pressure, adherence levels, and cardiovascular morbidity and mortality. Expected follow-up time is 5 years.
Primary outcome measure(s) 1. Mean SBP and DBP values obtained during office visit (measured at each visit with a semiautomatic sphygmomanometer (OMRON 705-CP). Main analysis will include blood pressure data until visit 3 (6 months).
Secondary outcome measure(s) 1. Medication adherence according to MEMS (medication event monitoring system) device results. Medication adherence data will include information on the first 6 months (visit 3). Apart from recording the date and time each time the container is opened, the information from the electronic device may be downloaded to a computer for further statistical analysis.
2. Time elapsed until the first cardiovascular morbidity or mortality event during follow-up (expected follow-up duration: 5 years).
2.1. Fatal events ascribable to cardiovascular pathology. the following will be included: sudden heart failure; fatal myocardial infarction; death during/post percutaneous transluminal coronary angioplasty (PTCA) or aortocoronary bypass; death due to congestive heart failure; fatal CVA.
2.2. Non-fatal events ascribable to cardiovascular pathology. the following will be included: debutant congestive heart failure requiring hospitalization or chronic congestive heart failure requiring hospitalization; non-fatal acute myocardial infarction, as verified by a ST-segment peak in the ECG and/or typical enzyme pattern; emergency thrombolytic treatment/fibrinolytic treatment and/or emergency PTCA/aortocoronary bypass to prevent extensive myocardial infarction, as verified by a ST-segment peak in the ECG and/or typical enzyme pattern; CVA verified by CAT or hospital recordings; angina diagnosed with positive treadmill test results; routine PTCA/aortocoronary bypass; unstable angina requiring hospitalization; silent myocardial infarction detected during the study and not present in the ECGs prior to the beginning of the study; terminal renal insufficiency, impaired renal function.
Sources of funding 1. Instituto de Salud Carlos III -Fondo de Investigación Sanitaria (Spanish Ministry of Health) (FIS00/0045-01 and FIS00/0045-02)
2. Catalan Agency for Health Technology Assessment and Research (AATM 02/24/98)
3. Novartis (COM99)
4. Almirall Prodesfarma (COM99)
5. Aventis (COM99)
Trial website
Publications 1. 2010 results in http://www.ncbi.nlm.nih.gov/pubmed/20823391
Contact name Dr  Manel  Pladevall
  Address Center for Health Services Research - Henry Ford Health System
1 Ford Place, Suite 3A
  City/town Detroit
  Zip/Postcode MI 48202
  Country United States of America
Sponsor Osona Foundation for Research and Health Education (Fundació d’Osona per a la Recerca i l’Educació Sanitàries [FORES]) (Spain)
  Address C/Francesc Pla
  City/town Vic
  Zip/Postcode 08500
  Country Spain
  Tel +34 937027710
  Fax +34 937027709
  Email fores@hgv.es
  Sponsor website: http://www.foresosona.org/
Date applied 24/08/2004
Last edited 02/12/2010
Date ISRCTN assigned 11/10/2004
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