HypertensionNCT05580549
Prevalence of Hazardous Alcohol Use in a Population With Hypertension in Primary Care
An observational study of Hypertension and Alcohol Drinking, run by Region Stockholm at 1 site in Sweden.
Trial summary
The goal of this observational cross-sectional study is to map the prevalence of hazardous alcohol use in 270 adult patients with hypertension in Primary Health Care (PHC). The main question it aims to answer is: What is the prevalence of hazardous alcohol use in a population with hypertension in primary care detected… Read more about this study
- Who is it for?
- Ages 30 to 85 years
- Conditions the study is for
- Hypertension, Alcohol Drinking, Alcohol Use, Unspecified
- What is being tested?
- Alcohol biomarker Phosphatidylethanol (PEth)
- How many people
- 270 participants
- Where
- 1 siteSweden
- Study dates
- 1 Mar 2022to 31 Dec 2023
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 30 to 85 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: From 2-3 PHCCs, in Stockholm region in Sweden, we will find patients with the extraction tool Medrave4. Patients with hypertension from the last two years will be extracted and the criteria for inclusion will be applied. A stratified and random sample will be created of three different groups of hypertension: Controlled, Uncontrolled and, Treatment resistant hypertension.
Who may be able to join
- Hypertension ICD-10 code I10.9.
- Age 30-85 years.
Who cannot join
- Not able to come to the primary health care centre
- Not understanding swedish
- Not speaking swedish
- Severe disease
- Dementia
- Serious mental illness
Trial locations and contacts
1 site in 1 country.
Åsa Thurfjell, MD contact
Sweden1 site, 1 recruiting
- Recruiting
Region Stockholm
Stockholm, 10431
Åsa Thurfjell, MD, asa.thurfjell@ki.se
Lena Lund, PhD, +46701655182, lena.lund@ki.se
About this study
Official title: Prevalence of Hazardous Alcohol Use in a Population With Hypertension in Primary Care Detected With PEth and AUDIT - Observational Cross-sectional Study
The goal of this observational cross-sectional study is to map the prevalence of hazardous alcohol use in 270 adult patients with hypertension in Primary Health Care (PHC). The main question it aims to answer is: What is the prevalence of hazardous alcohol use in a population with hypertension in primary care detected with PEth and AUDIT, analysed in relation to patients with controlled, uncontrolled and treatment resistant hypertension? Participants will, in conjunction with annual control of hypertension with a General Practitioner (GP) at their Primary Health Care Centre (PHCC), visit a study nurse. The study nurse will collect following data: • Physical measurements• Lifestyle habits• Quality of life and demographic data • Drugs for hypertension and comorbidity • Laboratory tests including Phosphatidylethanol (PEth).
Read the detailed description
Hypertension, tobacco smoking, and alcohol use are the three leading risk factors for global disease burden. Treatment of hypertensive disease is important for the prevention of atherosclerotic disease, atrial fibrillation, heart failure, stroke, and dementia. In Sweden 27 % of adults have hypertension and a majority are treated in PHC but only 37 % reach target blood pressure. Alcohol can be one factor behind the low number of goal completion of blood pressure level.
Prevalence of hazardous alcohol use in Sweden is between 10-30 % in adults. Alcohol has an important role for over 200 diagnoses. There is a causal and dose dependent relationship between blood pressure levels and regular alcohol intake. Previous studies have reported hypertension to be attributable to alcohol in a wide range, depending on for example population, sex, and cultural context. But studies about the prevalence of hazardous alcohol use in patients with hypertension is few or even lacking.
General Practitioners (GPs) miss to identify a majority (60-70%) of patients with hazardous alcohol use even though guidelines on hypertension include risk stratification and detection of harmful lifestyle and the fact that general practitioners find it important to talk about alcohol with their patients.
Alcohol Use Disorders Identification Test (AUDIT) is a validated screening test for hazardous and harmful use in PHC setting, although concerns have been raised to its sensitivity. GPs experience that patient underestimate their consumption and that AUDIT does not meet the requirements to be a useful tool to detect hazardous alcohol use and AUDIT is seldomly used in PHC.
The alcohol biomarker Phosphatidylethanol (PEth) has high sensitivity and specificity to detect alcohol use. PEth can detect chronic heavy consumption. PEth is one of the newest alcohol biomarkers, but despite promising characteristics of PEth it is not routinely applied in clinical practice. PEth is used in a variety of settings like addiction care, emergency rooms, treatment of HIV-patients and patients with liver disease. PEth has started to be used in PHC but few studies on the use of biomarkers for alcohol consumption have been carried out in PHC.
The Swedish National Board of Health and Welfare has presented methods to use for supporting patients to change hazardous alcohol use. First the GPs need to identify if the patient has hazardous alcohol use. To our knowledge studies on whether PEth is a useful tool to detect hazardous use in patients with hypertension, in a primary health care context, is scarce or missing.
Study design
Based on that 12% of the hypertensive patients is related to alcohol intake and a presumed prevalence of hazardous drinking of 15 % the required sample size, given an effect size of 21%, significance level 5%, and power of 80% using contingency tables with 2 degrees of freedom, the study will require 270 patients with an included 10 % to compensate for missing values.
To perform an effective recruitment of patients we will invite patients from three well-functioning PHCCs with approximately 15.000 listed patients. Criteria for well-functioning is stable management and staff, routines for handling hypertension as well as unhealthy life-style habits and ability to offer locals for the project. By using the tool Medrave4 all patients 30-85 years old with hypertension (ICD-10 diagnose code I10.9) will be extracted from the PHCCs. The patients will be stratified to three groups of hypertension: •Controlled (blood pressure < 140/90), •Uncontrolled (blood pressure ≥ 140/90) and, •Treatment resistant hypertension (≥ 140/90 with three or more drugs against hypertension). Strata groups will be randomised, and the patients will be invited top to bottom. Recruitment will stop when 30 patients from each group has been included.
The PHCCs operations manager invites patients by letter. Patients have the opportunity to register their interest in participating in the study by letter or phone. Patients can also notify that they do not wish to be contacted. After 2-3 weeks the study nurse calls the patients and ask if they want to participate. The study nurse makes an initial assessment of the inclusion and exclusion criteria over the phone.
At the visit with the study nurse the final assessment of inclusion and exclusion criteria will be made. Finally the patients will be included after written informed consent. At the visit following data will be collected and stored at the digital platform REDCap:• Physical measurements (Blood pressure, pulse, weight, height, and waist measurement) • Lifestyle habits ( Alcohol, tobacco, food, and physical activity) • Quality of life (EQ-5D-5L) •Comorbidity with relevance to hypertension (Diabetes type 1 or 2, atrial fibrillation, angina pectoris, heart failure, myocardial infarction, stroke, and Transient ischemic attack) • Socioeconomic data (year of birth, gender, education, employment, occupation, people in the household) • Drugs for hypertension (Beta blockers, Calcium blockers, Thiazides, ACE inhibitors, ARB blockers, and Potassium-sparing diuretic) • Blood- and urine tests for hypertension and Phosphatidylethanol (PEth).
Patients will then visit their GP for an usual annual control of hypertension. The patients will receive results of blood tests and if needed adjustment of treatment will be done. Study nurse and GPs will talk about life style factors, including alcohol, with the patient. If hazardous alcohol use they will give short advice and offer more support if the patient needs and wants it. Before the start of the study GPs from the PHCCs will attend a short education of how to interpret PEth and AUDIT.
Detection of hazardous alcohol use, by the two methods PEth and AUDIT, will be described in the three strata (controlled, uncontrolled and treatment resistant hypertension) of the whole cohort. We will adjust for possible confounders (lifestyle factors, socio-economic data and patients' perceived health). We will relate our calculations to established risk stratification models for cardiovascular disease. All patients with hypertension and the drop-out population will be analysed according to what is ethically possible. Usual statistical presentation methods based on the scale level of collected data and other properties will be used.
- Conditions
- Hypertension, Alcohol Drinking, Alcohol Use, Unspecified
- Being tested
- Alcohol biomarker Phosphatidylethanol (PEth)
- Keywords
- Phosphatidylethanol, Alcohol Use Disorders Identification Test (AUDIT), Primary Health Care, Health promotion
- Medical subject headings
- Hypertension, Alcohol Drinking
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Alcohol biomarker Phosphatidylethanol (PEth)Diagnostic test
Also called Alcohol Use Disorders Identification Test (AUDIT)
The prevalence of hazardous alcohol use will be mapped through the biomarker PEth and the questionnaire AUDIT.
| Study group | Role | What they receive |
|---|---|---|
| Essential Hypertension | A representative sample of adult patients, with hypertension (ICD-10 diagnose code I10.9) from 2-3 PHCC in Stockholm Region, Sweden. Age 30-85 years old. Receives: Diagnostic Test: Alcohol biomarker Phosphatidylethanol (PEth) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Hazardous alcohol use
Measured PEth-value. Defined as > 0,3 µmol/L on PEth.
Measured: baseline
Hazardous alcohol use
Selfreported values. Defined as 6-13 points for women and 8-15 points for men on Alcohol Use Disorders Identification Test (AUDIT).
Measured: Baseline
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Oct 2022
- Study start1 Mar 2022
- Primary completion30 Jun 2023 (estimated)
- Study completion31 Dec 2023 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (21)Papers the sponsor has linked to this study.
- Other trials for HypertensionStudies of the same condition, open and under way.
- More trials run by Region StockholmThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Cross-sectional
- Enrolment
- 270 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Region Stockholm
- Sponsor type
- Other government
- Collaborators
- Karolinska Institutet, Forte, Sophiahemmet University
- Responsible party
- Sponsor
- Investigators
- Lena Lund, PhD, Principal investigator, Region Stockholm
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05580549
- Sponsor's protocol ID
- SLSO2022-0143
- Status last verified
- Oct 2022
- First submitted
- 12 Oct 2022
- Last updated
- 20 Oct 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C, Buchbinder R, Bull F, Burnett RT, Byers TE, Calabria B, Carapetis J, Carnahan E, Chafe Z, Charlson F, Chen H, Chen JS, Cheng AT, Child JC, Cohen A, Colson KE, Cowie BC, Darby S, Darling S, Davis A, Degenhardt L, Dentener F, Des Jarlais DC, Devries K, Dherani M, Ding EL, Dorsey ER, Driscoll T, Edmond K, Ali SE, Engell RE, Erwin PJ, Fahimi S, Falder G, Farzadfar F, Ferrari A, Finucane MM, Flaxman S, Fowkes FG, Freedman G, Freeman MK, Gakidou E, Ghosh S, Giovannucci E, Gmel G, Graham K, Grainger R, Grant B, Gunnell D, Gutierrez HR, Hall W, Hoek HW, Hogan A, Hosgood HD 3rd, Hoy D, Hu H, Hubbell BJ, Hutchings SJ, Ibeanusi SE, Jacklyn GL, Jasrasaria R, Jonas JB, Kan H, Kanis JA, Kassebaum N, Kawakami N, Khang YH, Khatibzadeh S, Khoo JP, Kok C, Laden F, Lalloo R, Lan Q, Lathlean T, Leasher JL, Leigh J, Li Y, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, Mak J, Malekzadeh R, Mallinger L, Marcenes W, March L, Marks R, Martin R, McGale P, McGrath J, Mehta S, Mensah GA, Merriman TR, Micha R, Michaud C, Mishra V, Mohd Hanafiah K, Mokdad AA, Morawska L, Mozaffarian D, Murphy T, Naghavi M, Neal B, Nelson PK, Nolla JM, Norman R, Olives C, Omer SB, Orchard J, Osborne R, Ostro B, Page A, Pandey KD, Parry CD, Passmore E, Patra J, Pearce N, Pelizzari PM, Petzold M, Phillips MR, Pope D, Pope CA 3rd, Powles J, Rao M, Razavi H, Rehfuess EA, Rehm JT, Ritz B, Rivara FP, Roberts T, Robinson C, Rodriguez-Portales JA, Romieu I, Room R, Rosenfeld LC, Roy A, Rushton L, Salomon JA, Sampson U, Sanchez-Riera L, Sanman E, Sapkota A, Seedat S, Shi P, Shield K, Shivakoti R, Singh GM, Sleet DA, Smith E, Smith KR, Stapelberg NJ, Steenland K, Stockl H, Stovner LJ, Straif K, Straney L, Thurston GD, Tran JH, Van Dingenen R, van Donkelaar A, Veerman JL, Vijayakumar L, Weintraub R, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams W, Wilson N, Woolf AD, Yip P, Zielinski JM, Lopez AD, Murray CJ, Ezzati M, AlMazroa MA, Memish ZA. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2224-60. doi: 10.1016/S0140-6736(12)61766-8.
PubMed 23245609Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-3104. doi: 10.1093/eurheartj/ehy339. No abstract available.
PubMed 30165516Holmquist C, Hasselstrom J, Bengtsson Bostrom K, Manhem K, Wettermark B, Hjerpe P, Kahan T. Improved treatment and control of hypertension in Swedish primary care: results from the Swedish primary care cardiovascular database. J Hypertens. 2017 Oct;35(10):2102-2108. doi: 10.1097/HJH.0000000000001429.
PubMed 28582282Rehm J, Gmel GE Sr, Gmel G, Hasan OSM, Imtiaz S, Popova S, Probst C, Roerecke M, Room R, Samokhvalov AV, Shield KD, Shuper PA. The relationship between different dimensions of alcohol use and the burden of disease-an update. Addiction. 2017 Jun;112(6):968-1001. doi: 10.1111/add.13757. Epub 2017 Feb 20.
PubMed 28220587Puddey IB, Mori TA, Barden AE, Beilin LJ. Alcohol and Hypertension-New Insights and Lingering Controversies. Curr Hypertens Rep. 2019 Sep 7;21(10):79. doi: 10.1007/s11906-019-0984-1.
PubMed 31494743Lang T, Degoulet P, Aime F, Devries C, Jacquinet-Salord MC, Fouriaud C. Relationship between alcohol consumption and hypertension prevalence and control in a French population. J Chronic Dis. 1987;40(7):713-20. doi: 10.1016/0021-9681(87)90108-1.
PubMed 3597673Marchi KC, Muniz JJ, Tirapelli CR. Hypertension and chronic ethanol consumption: What do we know after a century of study? World J Cardiol. 2014 May 26;6(5):283-94. doi: 10.4330/wjc.v6.i5.283.
PubMed 24944758Manthey J, Probst C, Hanschmidt F, Rehm J. Identification of smokers, drinkers and risky drinkers by general practitioners. Drug Alcohol Depend. 2015 Sep 1;154:93-9. doi: 10.1016/j.drugalcdep.2015.06.017. Epub 2015 Jun 22.
PubMed 26130336Hyland K, Hammarberg A, Andreasson S, Jirwe M. Treatment of alcohol dependence in Swedish primary care: perceptions among general practitioners. Scand J Prim Health Care. 2021 Jun;39(2):247-256. doi: 10.1080/02813432.2021.1922834. Epub 2021 Jun 21.
PubMed 34151724Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993 Jun;88(6):791-804. doi: 10.1111/j.1360-0443.1993.tb02093.x.
PubMed 8329970Higgins-Biddle JC, Babor TF. A review of the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and USAUDIT for screening in the United States: Past issues and future directions. Am J Drug Alcohol Abuse. 2018;44(6):578-586. doi: 10.1080/00952990.2018.1456545. Epub 2018 May 3.
PubMed 29723083Tam CW, Zwar N, Markham R. Australian general practitioner perceptions of the detection and screening of at-risk drinking, and the role of the AUDIT-C: a qualitative study. BMC Fam Pract. 2013 Aug 20;14:121. doi: 10.1186/1471-2296-14-121.
PubMed 23961835Nygaard P, Paschall MJ, Aasland OG, Lund KE. Use and barriers to use of screening and brief interventions for alcohol problems among Norwegian general practitioners. Alcohol Alcohol. 2010 Mar-Apr;45(2):207-12. doi: 10.1093/alcalc/agq002. Epub 2010 Jan 25.
PubMed 20100927Ulwelling W, Smith K. The PEth Blood Test in the Security Environment: What it is; Why it is Important; and Interpretative Guidelines. J Forensic Sci. 2018 Nov;63(6):1634-1640. doi: 10.1111/1556-4029.13874. Epub 2018 Jul 13.
PubMed 30005144Andresen-Streichert H, Muller A, Glahn A, Skopp G, Sterneck M. Alcohol Biomarkers in Clinical and Forensic Contexts. Dtsch Arztebl Int. 2018 May 4;115(18):309-315. doi: 10.3238/arztebl.2018.0309.
PubMed 29807559
Study at a glance
From the registry record, last updated by the sponsor on 20 Oct 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Prevalence of Hazardous Alcohol Use in a Population With Hypertension in Primary Care Detected With PEth and AUDIT - Observational Cross-sectional Study
- ClinicalTrials.gov ID
- NCT05580549
- Acronym / sponsor ID
- SLSO2022-0143
- Conditions
- Hypertension, Alcohol Drinking, Alcohol Use, Unspecified
- Keywords
- Phosphatidylethanol, Alcohol Use Disorders Identification Test (AUDIT), Primary Health Care, Health promotion
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 270 participants (estimated)
- Lead sponsor
- Region StockholmOther government
- Collaborators
- Karolinska Institutet, Forte, Sophiahemmet University
- Study start
- 1 Mar 2022 (actual)
- Primary completion
- 30 Jun 2023 (estimated)
- Study completion
- 31 Dec 2023 (estimated)
- First posted
- 14 Oct 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this observational cross-sectional study is to map the prevalence of hazardous alcohol use in 270 adult patients with hypertension in Primary Health Care (PHC). The main question it aims to answer is: What is the prevalence of hazardous alcohol use in a population with hypertension in primary care detected with PEth and AUDIT, analysed in relation to patients with controlled, uncontrolled and treatment resistant hypertension? Participants will, in conjunction with annual control of hypertension with a General Practitioner (GP) at their Primary Health Care Centre (PHCC), visit a study nurse. The study nurse will collect following data: • Physical measurements• Lifestyle habits• Quality of life and demographic data • Drugs for hypertension and comorbidity • Laboratory tests including Phosphatidylethanol (PEth).
Detailed description
Hypertension, tobacco smoking, and alcohol use are the three leading risk factors for global disease burden. Treatment of hypertensive disease is important for the prevention of atherosclerotic disease, atrial fibrillation, heart failure, stroke, and dementia. In Sweden 27 % of adults have hypertension and a majority are treated in PHC but only 37 % reach target blood pressure. Alcohol can be one factor behind the low number of goal completion of blood pressure level.
Prevalence of hazardous alcohol use in Sweden is between 10-30 % in adults. Alcohol has an important role for over 200 diagnoses. There is a causal and dose dependent relationship between blood pressure levels and regular alcohol intake. Previous studies have reported hypertension to be attributable to alcohol in a wide range, depending on for example population, sex, and cultural context. But studies about the prevalence of hazardous alcohol use in patients with hypertension is few or even lacking.
General Practitioners (GPs) miss to identify a majority (60-70%) of patients with hazardous alcohol use even though guidelines on hypertension include risk stratification and detection of harmful lifestyle and the fact that general practitioners find it important to talk about alcohol with their patients.
Alcohol Use Disorders Identification Test (AUDIT) is a validated screening test for hazardous and harmful use in PHC setting, although concerns have been raised to its sensitivity. GPs experience that patient underestimate their consumption and that AUDIT does not meet the requirements to be a useful tool to detect hazardous alcohol use and AUDIT is seldomly used in PHC.
The alcohol biomarker Phosphatidylethanol (PEth) has high sensitivity and specificity to detect alcohol use. PEth can detect chronic heavy consumption. PEth is one of the newest alcohol biomarkers, but despite promising characteristics of PEth it is not routinely applied in clinical practice. PEth is used in a variety of settings like addiction care, emergency rooms, treatment of HIV-patients and patients with liver disease. PEth has started to be used in PHC but few studies on the use of biomarkers for alcohol consumption have been carried out in PHC.
The Swedish National Board of Health and Welfare has presented methods to use for supporting patients to change hazardous alcohol use. First the GPs need to identify if the patient has hazardous alcohol use. To our knowledge studies on whether PEth is a useful tool to detect hazardous use in patients with hypertension, in a primary health care context, is scarce or missing.
Study design
Based on that 12% of the hypertensive patients is related to alcohol intake and a presumed prevalence of hazardous drinking of 15 % the required sample size, given an effect size of 21%, significance level 5%, and power of 80% using contingency tables with 2 degrees of freedom, the study will require 270 patients with an included 10 % to compensate for missing values.
To perform an effective recruitment of patients we will invite patients from three well-functioning PHCCs with approximately 15.000 listed patients. Criteria for well-functioning is stable management and staff, routines for handling hypertension as well as unhealthy life-style habits and ability to offer locals for the project. By using the tool Medrave4 all patients 30-85 years old with hypertension (ICD-10 diagnose code I10.9) will be extracted from the PHCCs. The patients will be stratified to three groups of hypertension: •Controlled (blood pressure < 140/90), •Uncontrolled (blood pressure ≥ 140/90) and, •Treatment resistant hypertension (≥ 140/90 with three or more drugs against hypertension). Strata groups will be randomised, and the patients will be invited top to bottom. Recruitment will stop when 30 patients from each group has been included.
The PHCCs operations manager invites patients by letter. Patients have the opportunity to register their interest in participating in the study by letter or phone. Patients can also notify that they do not wish to be contacted. After 2-3 weeks the study nurse calls the patients and ask if they want to participate. The study nurse makes an initial assessment of the inclusion and exclusion criteria over the phone.
At the visit with the study nurse the final assessment of inclusion and exclusion criteria will be made. Finally the patients will be included after written informed consent. At the visit following data will be collected and stored at the digital platform REDCap:• Physical measurements (Blood pressure, pulse, weight, height, and waist measurement) • Lifestyle habits ( Alcohol, tobacco, food, and physical activity) • Quality of life (EQ-5D-5L) •Comorbidity with relevance to hypertension (Diabetes type 1 or 2, atrial fibrillation, angina pectoris, heart failure, myocardial infarction, stroke, and Transient ischemic attack) • Socioeconomic data (year of birth, gender, education, employment, occupation, people in the household) • Drugs for hypertension (Beta blockers, Calcium blockers, Thiazides, ACE inhibitors, ARB blockers, and Potassium-sparing diuretic) • Blood- and urine tests for hypertension and Phosphatidylethanol (PEth).
Patients will then visit their GP for an usual annual control of hypertension. The patients will receive results of blood tests and if needed adjustment of treatment will be done. Study nurse and GPs will talk about life style factors, including alcohol, with the patient. If hazardous alcohol use they will give short advice and offer more support if the patient needs and wants it. Before the start of the study GPs from the PHCCs will attend a short education of how to interpret PEth and AUDIT.
Detection of hazardous alcohol use, by the two methods PEth and AUDIT, will be described in the three strata (controlled, uncontrolled and treatment resistant hypertension) of the whole cohort. We will adjust for possible confounders (lifestyle factors, socio-economic data and patients' perceived health). We will relate our calculations to established risk stratification models for cardiovascular disease. All patients with hypertension and the drop-out population will be analysed according to what is ethically possible. Usual statistical presentation methods based on the scale level of collected data and other properties will be used.
Study design
- Observational model
- Cohort
- Time perspective
- Cross-sectional
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Essential Hypertension | – | Diagnostic Test: Alcohol biomarker Phosphatidylethanol (PEth)A representative sample of adult patients, with hypertension (ICD-10 diagnose code I10.9) from 2-3 PHCC in Stockholm Region, Sweden. Age 30-85 years old. |
Who may qualify
- Ages
- 30 to 85 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- From 2-3 PHCCs, in Stockholm region in Sweden, we will find patients with the extraction tool Medrave4. Patients with hypertension from the last two years will be extracted and the criteria for inclusion will be applied. A stratified and random sample will be created of three different groups of hypertension: Controlled, Uncontrolled and, Treatment resistant hypertension.
Key inclusion criteria (2 listed)
- Hypertension ICD-10 code I10.9.
- Age 30-85 years.
Key exclusion criteria (6 listed)
- Not able to come to the primary health care centre
- Not understanding swedish
- Not speaking swedish
- Severe disease
- Dementia
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Alcohol biomarker Phosphatidylethanol (PEth)Also: Alcohol Use Disorders Identification Test (AUDIT)The prevalence of hazardous alcohol use will be mapped through the biomarker PEth and the questionnaire AUDIT. | Diagnostic test | Essential Hypertension |
Primary outcome
Hazardous alcohol use
Time frame: baseline
Measured PEth-value. Defined as > 0,3 µmol/L on PEth.
Hazardous alcohol use
Time frame: Baseline
Selfreported values. Defined as 6-13 points for women and 8-15 points for men on Alcohol Use Disorders Identification Test (AUDIT).
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 20 Oct 2022.
- Background: PubMed 23245609Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C, Buchbinder R, Bull F, Burnett RT, Byers TE, Calabria B, Carapetis J, Carnahan E, Chafe Z, Charlson F, Chen H, Chen JS, Cheng AT, Child JC, Cohen A, Colson KE, Cowie BC, Darby S, Darling S, Davis A, Degenhardt L, Dentener F, Des Jarlais DC, Devries K, Dherani M, Ding EL, Dorsey ER, Driscoll T, Edmond K, Ali SE, Engell RE, Erwin PJ, Fahimi S, Falder G, Farzadfar F, Ferrari A, Finucane MM, Flaxman S, Fowkes FG, Freedman G, Freeman MK, Gakidou E, Ghosh S, Giovannucci E, Gmel G, Graham K, Grainger R, Grant B, Gunnell D, Gutierrez HR, Hall W, Hoek HW, Hogan A, Hosgood HD 3rd, Hoy D, Hu H, Hubbell BJ, Hutchings SJ, Ibeanusi SE, Jacklyn GL, Jasrasaria R, Jonas JB, Kan H, Kanis JA, Kassebaum N, Kawakami N, Khang YH, Khatibzadeh S, Khoo JP, Kok C, Laden F, Lalloo R, Lan Q, Lathlean T, Leasher JL, Leigh J, Li Y, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, Mak J, Malekzadeh R, Mallinger L, Marcenes W, March L, Marks R, Martin R, McGale P, McGrath J, Mehta S, Mensah GA, Merriman TR, Micha R, Michaud C, Mishra V, Mohd Hanafiah K, Mokdad AA, Morawska L, Mozaffarian D, Murphy T, Naghavi M, Neal B, Nelson PK, Nolla JM, Norman R, Olives C, Omer SB, Orchard J, Osborne R, Ostro B, Page A, Pandey KD, Parry CD, Passmore E, Patra J, Pearce N, Pelizzari PM, Petzold M, Phillips MR, Pope D, Pope CA 3rd, Powles J, Rao M, Razavi H, Rehfuess EA, Rehm JT, Ritz B, Rivara FP, Roberts T, Robinson C, Rodriguez-Portales JA, Romieu I, Room R, Rosenfeld LC, Roy A, Rushton L, Salomon JA, Sampson U, Sanchez-Riera L, Sanman E, Sapkota A, Seedat S, Shi P, Shield K, Shivakoti R, Singh GM, Sleet DA, Smith E, Smith KR, Stapelberg NJ, Steenland K, Stockl H, Stovner LJ, Straif K, Straney L, Thurston GD, Tran JH, Van Dingenen R, van Donkelaar A, Veerman JL, Vijayakumar L, Weintraub R, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams W, Wilson N, Woolf AD, Yip P, Zielinski JM, Lopez AD, Murray CJ, Ezzati M, AlMazroa MA, Memish ZA. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2224-60. doi: 10.1016/S0140-6736(12)61766-8.
- Background: PubMed 30165516Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-3104. doi: 10.1093/eurheartj/ehy339. No abstract available.
- Background: PubMed 28582282Holmquist C, Hasselstrom J, Bengtsson Bostrom K, Manhem K, Wettermark B, Hjerpe P, Kahan T. Improved treatment and control of hypertension in Swedish primary care: results from the Swedish primary care cardiovascular database. J Hypertens. 2017 Oct;35(10):2102-2108. doi: 10.1097/HJH.0000000000001429.
- Background: PubMed 28220587Rehm J, Gmel GE Sr, Gmel G, Hasan OSM, Imtiaz S, Popova S, Probst C, Roerecke M, Room R, Samokhvalov AV, Shield KD, Shuper PA. The relationship between different dimensions of alcohol use and the burden of disease-an update. Addiction. 2017 Jun;112(6):968-1001. doi: 10.1111/add.13757. Epub 2017 Feb 20.
- Background: PubMed 31494743Puddey IB, Mori TA, Barden AE, Beilin LJ. Alcohol and Hypertension-New Insights and Lingering Controversies. Curr Hypertens Rep. 2019 Sep 7;21(10):79. doi: 10.1007/s11906-019-0984-1.
- Background: PubMed 3597673Lang T, Degoulet P, Aime F, Devries C, Jacquinet-Salord MC, Fouriaud C. Relationship between alcohol consumption and hypertension prevalence and control in a French population. J Chronic Dis. 1987;40(7):713-20. doi: 10.1016/0021-9681(87)90108-1.
- Background: PubMed 24944758Marchi KC, Muniz JJ, Tirapelli CR. Hypertension and chronic ethanol consumption: What do we know after a century of study? World J Cardiol. 2014 May 26;6(5):283-94. doi: 10.4330/wjc.v6.i5.283.
- Background: PubMed 26130336Manthey J, Probst C, Hanschmidt F, Rehm J. Identification of smokers, drinkers and risky drinkers by general practitioners. Drug Alcohol Depend. 2015 Sep 1;154:93-9. doi: 10.1016/j.drugalcdep.2015.06.017. Epub 2015 Jun 22.
- Background: PubMed 34151724Hyland K, Hammarberg A, Andreasson S, Jirwe M. Treatment of alcohol dependence in Swedish primary care: perceptions among general practitioners. Scand J Prim Health Care. 2021 Jun;39(2):247-256. doi: 10.1080/02813432.2021.1922834. Epub 2021 Jun 21.
- Background: PubMed 8329970Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993 Jun;88(6):791-804. doi: 10.1111/j.1360-0443.1993.tb02093.x.
- Background: PubMed 29723083Higgins-Biddle JC, Babor TF. A review of the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and USAUDIT for screening in the United States: Past issues and future directions. Am J Drug Alcohol Abuse. 2018;44(6):578-586. doi: 10.1080/00952990.2018.1456545. Epub 2018 May 3.
- Background: PubMed 23961835Tam CW, Zwar N, Markham R. Australian general practitioner perceptions of the detection and screening of at-risk drinking, and the role of the AUDIT-C: a qualitative study. BMC Fam Pract. 2013 Aug 20;14:121. doi: 10.1186/1471-2296-14-121.
- The National Board of Health and Welfare 2018: National guidelines for disease prevention methodsLink provided by the sponsor.
- The Central Association for Alcohol and Narcotic Information (CAN): Self-reported alcohol habits in Sweden 2004-2020. CAN report 204Link provided by the sponsor.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Åsa Thurfjell, MD contact
Lena Lund, PhD principal investigator
Region Stockholm
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Hypertension and Alcohol Drinking, run by Region Stockholm at 1 site in Sweden.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 20 Oct 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Lena Lund, PhD (+46701655182, lena.lund@ki.se), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Hazardous alcohol use (time frame: baseline). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05580549, which also lists 21 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Oct 2022.