Essential Hypotension and Allostasis Registry

NCT02018497 | Unknown

• 1 other identifier: LEMD001
• Study Type: observational
• Target: 5,000
• Locations: 1 country
• Sites: 1

Brief Summary

The essential arterial hypotension and allostasis registry is a prospective, observational research that has the purpose of demonstrating that essential blood pressure (BP) disorders and the associated comorbidities are a result of the inappropriate allostatic response to daily life stress. This required a functioning brain orchestrating the evaluation of the threat and choosing the response, this is a mind-mediated phenomenon. If the response is excessive it contributes to high BP, if deficient to low BP, and the BP itself will identify the allostatic pattern, which in turn will play an important role in the development of the comorbidities. To do so, consecutive patients of any age and gender that visit a cardiologist's office in Medellin, Colombia, are recruited. Individuals are classified according to their arterial BP and allostasis and follow them in time to see what kind of diseases develops the most (including BP) in the follow up according to the categorization of the characteristic chosen and after adjustment for confounder's variables. In addition, stress events with their date are registered. HYPOTHESIS The causes of the diseases are multifactorial. Physical, biochemical, psychological, social, and cultural dimensions of development dynamically interact to shape the health development process. A person´s health depends on their:

1. 1.Biological and physiologic systems
2. 2.External and internal environment (a) physical, b) internal behavioural and arousal state as registered by the brain.
3. 3.Their interaction.
4. 4.Functional systems; mediated by:
5. 5.The Autonomic Nervous System
6. 6.The endocrine system
7. 7.The immune system
8. 8.Structural changes: whenever the internal and/or external stressors are long lasting and/or strength enough, they may induce changes in:
9. 9.Epigenetic, endophenotypes, polyphenism.
10. 10.Plasticity
11. 11.The interaction between a) and b).

Conditions

Blood Pressure; Depression; Panic Attack; Fibromyalgia; POTS; Inappropriate Sinus Tachycardia; Coronary Heart Disease; Acute Coronary Syndrome (ACS); Acute Myocardial Infarction (AMI); Cerebrovascular Disease (CVD); Transient Ischemic Attack (TIA); Atrial Fibrillation; Diabetes Mellitus; Cancer; Systolic Heart Failure; Diastolic Heart Failure; Chronic Fatigue Syndrome; Syncope; Vasovagal Syncope

Keywords

Essential arterial hypotension; Arterial hypotension; Low blood pressure; Hypotension; Essential arterial hypertension; Syncope; Dysautonomia; Stress; Adaptability; Reactivity; Homeostasis; Allostasis; Allostatic load; Distress; Epigenetic; Plasticity

Outcome Measures

Primary Outcomes (3)

• Relationship between Blood pressure group and comorbidities

  Blood pressure group: 1) Essential arterial hypotension, 2) normotension and 3) Essential arterial hypertension. Comorbidities: As describe in the protocol, as a summary: 1) cardiovascular, 2) metabolic, 3) Endocrine, 4) psychiatric disorders: depression and panic disorder, 5) orthostatic intolerance: neurally mediated syncope, vasovagal syncope, inappropriate sinus tachycardia, Postural orthostatic syndrome, carotid sinus hypersensitivity; 6) others: chronic fatigue syndrome, fibromyalgia, arthritis, autoimmune diseases, pulmonary thromboembolism, OSA (obstructive sleep apnea), Alzheimer disease, Parkinson disease, others dementias, epilepsia, nephropathies, and others. Cardiovascular mortality Total mortality

  A 7-year prospective study

• Relationship between adaptability group and comorbidities

  Adaptability group: Hyper adaptable, normal adaptability, hypo adaptable. Comorbidities: As describe in the protocol, as a summary: 1) cardiovascular, 2) metabolic, 3) Endocrine, 4) psychiatric disorders: depression and panic disorder, 5) orthostatic intolerance: neurally mediated syncope, vasovagal syncope, inappropriate sinus tachycardia, Postural orthostatic syndrome, carotid sinus hypersensitivity; 6) others: chronic fatigue syndrome, fibromyalgia, arthritis, autoimmune diseases, pulmonary thromboembolism, OSA (obstructive sleep apnea), Alzheimer disease, Parkinson disease, others dementias, epilepsia, nephropathies, and others. Cardiovascular mortality Total mortality

  A 7-year prospective study

• Relationship between blood pressure group, adaptability group and comorbidities

  Blood pressure group: 1) Essential arterial hypotension, 2) normotension and 3) Essential arterial hypertension. Adaptability group: Hyper adaptable, normal adaptability, hypo adaptable. Comorbidities: As describe in the protocol, as a summary: 1) cardiovascular, 2) metabolic, 3) Endocrine, 4) psychiatric disorders: depression and panic disorder, 5) orthostatic intolerance: neurally mediated syncope, vasovagal syncope, inappropriate sinus tachycardia, Postural orthostatic syndrome, carotid sinus hypersensitivity; 6) others: chronic fatigue syndrome, fibromyalgia, arthritis, autoimmune diseases, pulmonary thromboembolism, OSA (obstructive sleep apnea), Alzheimer disease, Parkinson disease, others dementias, epilepsia, nephropathies, and others. Cardiovascular mortality Total mortality

  A 7-year prospective study

Secondary Outcomes (4)

• Relationship between blood pressure group, habits and anthropometric, metabolic, endocrine, Electrocardiogram, Holter, ambulatory blood pressure monitoring (ABPM)

  A 7-year prospective study

• Relationship between blood pressure group, adaptability group, habits anthropometric, metabolic, endocrine, electrocardiographic, Holter, ambulatory arterial blood pressure monitoring.

  A 7-year prospective study

• For metabolic disorders what it matters the most: the anthropometric variables vs blood pressure group vs adaptability group

  A 7-year prospective study

• Relationship between adaptability group, habits and anthropometric, metabolic, endocrine, Electrocardiogram, Holter, ambulatory blood pressure monitoring (ABPM)

  A 7-year prospective study

Other Outcomes (10)

• Syncope Registry

  Up 100 weeks

• Tilt table testing (TTT) registry

  Up to 100 weeks

• Sinus node function at the electrophysiological study (EPS)

  Up to 100 weeks

Study Arms (1)

Consecutive patients who consult a cardiologist

Consecutive patients who consult a cardiologist - electrophysiologist since June 2006, regardless of the age or gender in the city of Medellin, Colombia. They could have consulted previously (considered as the enrollment date) if they had, at least, one measurement of their BP in supine position, and an immediate measurement of their BP in standing position that allows diagnosing their group of blood pressure. All patients have a record in paper and/or magnetic file and in OpenClinica. No interventions.

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Consecutive patients that visits a cardiologist's office in Medellin, Colombia. The population consists of patients of any age and gender, which are classified according to their blood pressure in: normotensive, hypertensive and hypotensive, they are also classified according to their adaptability in hypo, normo and hyper.

You may qualify if:

• Any patient regardless of the age of gender

You may not qualify if:

• Any non-correctable secondary cause of increase or decrease in blood pressure
• or a pathology that alters the prognosis before the entrance of the patient into this registry.
• nephropathy prior to the admission,
• familial dyslipidemia,
• previous gastric bypass,
• pre-existing heart failure,
• chemotherapy-induced cardiotoxicity,
• arrhythmogenic right ventricular dysplasia,
• long QT syndrome,
• hypertrophic cardiomyopathy
• restrictive cardiomyopathy or sudden death syndromes other than coronary disease
• Down syndrome,
• having one single kidney before entering to this registry,
• polycystic kidney,
• disability to continue with the treatment

Sponsors & Collaborators

• CES University: lead

Study Sites (1)

CES University

Medellín, Antioquia, 00, Colombia

RECRUITING

Related Publications (107)

• Medina E, Uribe W, Duque M, Alzate L. Past Medical History in patients with Orthostatic Intolerance. XIth International Symposium on the Autonomic Nervous System, Puerto Rico, 24-30. October 2000. Clin Auton Res 2000, 10:258. Summary.

  BACKGROUND

• Medina E, Uribe W, Duque M, Alzate L. Initial Medical Complain and Symptoms in Patients with Orthostatic Intolerance. XIth International symposium on the autonomic nervous system, Puerto Rico, 24-30 October 2000. Clin Auton Res 2000, 10:258. Summary

  BACKGROUND

• Medina E, Uribe W, Duque M, Alzate L. Syncope characterization in patients with orthostatic intolerance. XIth International symposium on the autonomic nervous system, Puerto Rico, 24-30 October 2000. Clin Auton Res 2000, 10:243. Summary.

  BACKGROUND

• Medina E, Uribe W, Duque M, Alzate L. Patients with orthostatic Intolerance: are those with syncope different from those without? Is syncope an acceptable endpoint for therapy? XIth International Symposium on the Autonomic Nervous System, Puerto Rico, 24-30 October 2000. Clin Auton Res 2000, 10:243. Summary

  BACKGROUND

• Medina E, Uribe W, Duque M, Alzate L. Variation of arterial blood pressure and heart rate during follow up in patients with orthostatic intolerance. XIth International symposium on the autonomic nervous system, Puerto Rico, 24-30 October 2000. Summary.

  BACKGROUND

• Medina E, Uribe W, Duque M, Alzate L. Severity of Compromise and level of Limitation in patients with Orthostatic Intolerance. XIth International Symposium on the autonomic nervous system, Puerto Rico, 24-30 October 2000. Summary

  BACKGROUND

• Medina E, Uribe W, Duque M, Alzate L. Diagnosis of orthostatic intolerance based on blood pressure and heart rate characterization. Could symptoms be enough?. XIth International symposium on the autonomic nervous system, Puerto Rico, 24-30 October 2000. Summary

  BACKGROUND

• Medina L, Mármol A, Duque M, Ossaba S, Uribe W, Olaya M, Marín J, Torres Y, Velásquez J. The tilt table test protocol: How can be improved? Clinical Autonomic Research. Vol 14, Number 5, 2004, page. 310. October 2000. Summary

  BACKGROUND

• Medina L, Olaya M, Duque M, Restrepo F, Uribe W, Marín J, Velásquez J, Torres Y. Fatigue: a clue symptom in chronic orthostatic disorder. How can it be explained? Clinical Autonomic Research. Vol 14, Number 5, 2004, page. 310. October 2000. Summar

  BACKGROUND

• L Medina, W Uribe, M Duque, I Melguizo, JM Cotes, Y Torres, MA Restrepo, J Marín, E Gil, J Velasquez. Cardiology and autonomic nervous system department. Clínica Medellín, Universidad CES, Universidad Nacional. Medellín, Colombia. Personality type: a variable associated with biological measures in patients with orthostatic intolerance. 16th International symposium on the autonomic nervous system. Los Cabos, Mexico. October 6-9 2005. Clinical Autonomic Research. Vol 15, number 5, page 346, 2005. Summary.

  BACKGROUND

• L Medina, W Uribe, M Duque, I Melguizo, JM Cotes, Y Torres, MA Restrepo, J Marín, E Gil, J Velasquez. Cardiology and autonomic nervous system department. Clínica Medellín, Universidad CES, Universidad Nacional. Medellín, Colombia. Descriptive analysis and confidence limits at 95% of stress, depression, SF36, and tilt-test variables in an orthostatic intolerant population. 16th International symposium on the autonomic nervous system. Los Cabos, Mexico, October 6-9 2005. Clinical Autonomic Research. Vol 15, number 5, page 342, 2005. Summary.

  BACKGROUND

• L Medina, D Aristizabal, M Duque, W Uribe, I Melguizo, JM Cotes, Y Torres, MA Restrepo, J Marín, E Gil, J Velásquez, BLF Restrepo. Cardiology and autonomic nervous system department. Clínica Medellín, Universidad CES, Universidad Nacional and Universidad de Antioquia. Medellín, Colombia. Insulin and glucose metabolism in patients with orthostatic intolerance. 16th International symposium on the autonomic nervous system. Los Cabos, Mexico. October 6-9 2005. Clinical Autonomic Research. Vol 15, number 5, page 333, 2005. Summary.

  BACKGROUND

• L Medina, M Duque, E Gil, JM Cotes, Marín J, D Bravo, E Gonzalez, MA Restrepo, D Aristizabal, Y Torres, M Jimenez, W Uribe. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Applying tilt testing to diagnose sick sinus syndrome: Does it play role beyond syncope? 17th International symposium on the autonomic nervous system. Westin Riomar, Rio Grande, Puerto Rico, November 1-4 2006. Clinical Autonomic Research. Vol 16, number 5, page 349, 2006. Summary.

  BACKGROUND

• L Medina , J McEween, J Mendez, W Uribe, M Duque, Marín J E Gil, D Bravo, E Gonzalez, MA Restrepo, Torres Y, Cotes JM. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Hemodynamic effects of the 16 Gly/Arg polymorphism at the ADRB2 gene in hypotensive and hypertensive patients. 17th International symposium on the autonomic nervous system. Westin Riomar, Rio Grande, Puerto Rico, November 1-4 2006. Clinical Autonomic Research. Vol 16, Number 5, page 333, 2006. Summary.

  BACKGROUND

• L Medina, D Aristizabal, J McEween, J Mendez, W Uribe, Duque M, Marín J E Gil, D Bravo, E Gonzalez, MA Restrepo, Torres Y, Cotes JM. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Diagnostic impact of the syncope symptom score in structurally normal hearts in patients undergoing tilt table testing. 17th International Symposium on the Autonomic Nervous System. Westin Riomar, Rio Grande, Puerto Rico, November 1-4 2006. Clinical Autonomic Research. Vol 16, Number 5, page 342, 2006. Summary.

  BACKGROUND

• LE Medina, D Aristizabal, J Gallo, J Ochoa, Y Torres, L Montoya, M Correa, R Restrepo, D Moreno, MO Correa, N Zapata, PA Gil, M Franco. Medellin heart study. Study design and distribution by blood pressure, including hypotension. Clinical Autonomic Research. Vol 18, Number 5, page 277, 2008. (Summary).

  BACKGROUND

• Medina L, Duque M, Marin J, Gonzalez E, Astudillo V, Aristizabal J, Bernal J, Restrepo MA, Arroyave A, Jaramillo G, Torres Y, Uribe W. Essential hypotension registry: Sympathovagal balance at 24 hours, day and night in ambulatory Holter monitoring according to blood pressure groups in real-life settings. Clinical Autonomic Research. Vol 19, Number 5, page 300, 2009. Summary.

  BACKGROUND

• Medina LE, Duque M, Uribe W, Aristizabal J, Velasquez J, Restrepo MA, Miranda A, Torres Y, Marin J. The essential hypotension registry. Blood pressure at the office and at 24 h ambulatory monitoring is different between groups of essential hypertension, normotension and essential hypotension. Clinical Autonomic Research. Vol 20, number 2, page 139, 2010. Summary.

  BACKGROUND

• Medina LE, Marin J, Duque M, Uribe W, Mesa S, Aristizabal J, Velasquez J, Restrepo MA, Miranda A, Bernal J, Torres Y. Vasovagal syncope and their relationship with hypotension: What is the current conception and how it may change if essential hypotensive population emerges. The essential hypotension registry. Clinical Autonomic Research. Vol 21, number 2, page 127, 201. Summary

  BACKGROUND

• Medina L, Duque M, Marin J, Gonzalez E, Astudillo V, Aristizabal J, Bernal J, Restrepo MA, Arroyave A, Jaramillo G, Torres Y, Uribe W. Syncope diagnosis in patients with not apparent structurally heart disease and components for both: neurally mediated and cardiac origin (mixed syncope): is it a quantitative history score reliable? Clinical Autonomic Research. Vol 19, number 5, page 308, 2009. Summary.

  BACKGROUND

• Medina L. Essential hypotension registry. Cardiovascular Reactivity: A search for the integration of the neuro-cardiovascular relationship and their association with glucose challenge and depression. Clinical Autonomic Research. Vol 19, number 5, page 300, 2009. Summary

  BACKGROUND

• LE Medina, Aristizabal D, McEween J, W Uribe, Duque M, Marín J Gil E, Bravo D, Gonzalez E, Restrepo MA, Torres Y, Cotes JM. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Are there insulin sensitivity differences expected along the blood pressure spectrum? 17th International symposium on the autonomic nervous system. Westin Riomar, Rio Grande, Puerto Rico, November 1-4 2006. Clinical Autonomic Research. Vol 16, number 5, page 332, 2006. Summary

  BACKGROUND

• LE Medina, W Uribe, M Duque, E Gonzalez, G Montero, D Bravo, MA Restrepo, M Jimenez, D Aristizábal, T Torres, J Marín. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Does essential or primary hypotension matter? Second joint meeting of the European Federation of Autonomic Societies and the American Autonomic Society. Palais Ferstel. Vienna, Austria. October 10-13, 2007. Clinical Autonomic Research. Vol 17, number 5, page 304, 2007. Summary.

  BACKGROUND

• LE Medina, J Marín, W Uribe, M Duque, E Gonzalez, G Montero, D Bravo, MA Restrepo, M Jimenez, D Aristizabal. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Population characterization according to blood pressure. Are essential hypotensive different from other blood pressure groups? Second joint meeting of the European Federation of Autonomic Societies and the American Autonomic Society. Palais Ferstel. Vienna, Austria. October 10-13, 2007. Clinical Autonomic Research. Vol 17, number 5, page 304, 2007. Summary

  BACKGROUND

• LE Medina, W Uribe, J Marín, E Gonzalez, G Montero, D Bravo, MA Restrepo, M Jimenez, D Aristizabal, M Duque. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. The importance of arterial hypotension in the chronic fatigue syndrome. Second joint meeting of the European Federation of Autonomic Societies and the American Autonomic Society. Palais Ferstel. Vienna, Austria. October 10-13, 2007. Clinical Autonomic Research. Vol 17, number 5, page 318, 2007. Summary.

  BACKGROUND

• LE Medina, M Duque, J Marín, E Gonzalez, G Montero, D Bravo, MA Restrepo, M Jimenez, D Aristizabal, W Uribe. Cardiology and autonomic nervous system department. Clínica Medellín, Medellín, Colombia. Are there differences in the variables hemoglobin, hematocrit and ferritin between normotensive patients and essential hypertensive and hypotensive? Second joint meeting of the European Federation of Autonomic Societies and the American Autonomic Society. Palais Ferstel. Vienna, Austria. October 10-13, 2007. Clinical Autonomic Research. Vol 17, number 5, page 311, 2007. Summary

  BACKGROUND

• LE Medina, J Ospina, MA Lemos, G Cuartas, D Aristizabal, J Calle, Gutierrez, Y Torres. Relationship between blood pressure, depression and anxiety. A step into the concept of psychobiotype (mind-body relationship). Clinical Autonomic Research. Vol 18, number 5, page 277, 2008. Summary

  BACKGROUND

• LE Medina, W Uribe, J Marin, G Montero, B Astudillo, MA Restrepo, J Bernal, Y Torres, M Duque. Blood pressure characterization in essentials hypotension and/or orthostatic hypotension. Clinical Autonomic Research. Vol 18, number 5, page 277, 2008. Summary.

  BACKGROUND

• Medina L, Uribe W, Marin J, Gonzalez E, Astudillo V, Aristizabal J, Velasquez J, Bernal J, Torres Y, Duque M. Chronotropic incompetence in the head-up tilt testing: a useful diagnostic marker or clinically irrelevant finding? Accepted for publication at the European Heart Journal, 2009 (Summary).

  BACKGROUND

• Medina L. Essential Hypotension registry: Definition, blood pressure and demographic report. Clinical Autonomic Research. Vol 19, number 5, page 308, 2009. Summary

  BACKGROUND

• Medina LE, Ospina J, Lemos MA, Cuartas G, Calle J, Gutierrez M, Torres Y. Essential hypotension registry: Psychometric measurements for anxiety, depression and coping strategies: Hypotension is associated with depression and anxiety. Is there a psycho-biotype? Preliminary Report. Clinical Autonomic Research. Vol 19, number 5, page 296, 2009. Summary

  BACKGROUND

• Medina LE, Duque M, Uribe W, Aristizabal J, Velasquez J, Restrepo MA, Miranda A, Torres Y, Marin J. It is glucose metabolism (HOMA and the relation: 2 h postprandial plasma glucose/fasting glucose) different between blood pressure groups? The essential hypotension registry. Clinical Autonomic Research. Vol 20, number 2, page 139, 2010. Summary.

  BACKGROUND

• Medina LE, Duque M, Marin J, Aristizabal J, Velasquez J, Miranda A, Torres Y, Restrepo MA, Uribe W. The essential hypotension registry. Rationale for the blood pressure classification and the importance of the stress response. Clinical Autonomic Research. Vol 20, number 2, page 139, 2010. Summary

  BACKGROUND

• Medina LE, Uribe W, Marin J, Aristizabal J, Velasquez J, Miranda A, Torres Y, Restrepo MA, Duque M. What do patients with classical and initial orthostatic hypotension, without an identifiable cause have to teach us? The essential hypotension registry. Description of the population and the blood pressure measurements. Clinical Autonomic Research. Vol 20, number 2, page 140, 2010. Summary

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• Medina LE, Uribe W, Marin J, Aristizabal J, Velasquez J, Miranda A, Torres Y, Restrepo MA, Duque M. The importance of essential hypotension in syncope. A report of 877 patients. The essential hypotension registry. Clinical. Autonomic Research. Vol 20, number 2, page 140, 2010. Summary

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MeSH Terms

Conditions

Depression; Panic Disorder; Fibromyalgia; Coronary Disease; Acute Coronary Syndrome; Cerebrovascular Disorders; Ischemic Attack, Transient; Atrial Fibrillation; Diabetes Mellitus; Neoplasms; Heart Failure, Systolic; Heart Failure, Diastolic; Fatigue Syndrome, Chronic; Syncope; Syncope, Vasovagal; Hypotension; Autonomic Nervous System Diseases

Condition Hierarchy (Ancestors)

Behavioral Symptoms; Behavior; Anxiety Disorders; Mental Disorders; Muscular Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Neuromuscular Diseases; Nervous System Diseases; Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Brain Diseases; Central Nervous System Diseases; Brain Ischemia; Arrhythmias, Cardiac; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Heart Failure; Encephalomyelitis; Neuroinflammatory Diseases; Chronic Disease; Disease Attributes; Unconsciousness; Consciousness Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Signs and Symptoms; Orthostatic Intolerance; Primary Dysautonomias

Study Officials

• Luis Eduardo Medina, MD.

  Researcher

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Luis Eduardo Medina, MD.

CONTACT

(574)2323218; essentialhypotension@gmail.com

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Target Duration: 15 Years
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Researcher

Study Record Dates

• First Submitted: November 29, 2013
• First Posted: December 23, 2013
• Study Start: January 1, 1995
• Primary Completion: March 30, 2024
• Study Completion: June 30, 2024
• Last Updated: September 21, 2023

Record last verified: 2023-09

Locations

CO (1)