xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT05971407</url>
    </required_header>
    <id_info>
      <org_study_id>FMHS 34-0722</org_study_id>
      <nct_id>NCT05971407</nct_id>
    </id_info>
    <brief_title>The Effect of Chronic Remote Ischaemic Preconditioning on Blood Pressure in Older Adults</brief_title>
    <acronym>RIPCo</acronym>
    <official_title>The Effect of Chronic Remote Ischaemic Preconditioning on Blood Pressure in Older Adults</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Harry Keevil</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>University of Nottingham</source>
    <oversight_info>
      <has_dmc>Yes</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        The purpose of this study is to assess whether remote ischaemic conditioning, applied&#xD;
        chronically, improves vascular health in older adults&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        Hypertension and stroke remain leading causes of mortality across the world (1). Hypertension&#xD;
        affects more than 1 in 4 adults and is the 3rd biggest risk factor for premature death and&#xD;
        disability in the UK (2). Cerebrovascular disease is ranked 4th in the list of leading causes&#xD;
        of death in the UK (3). At present, the treatment of these conditions largely involves&#xD;
        chronic pharmacotherapy. In parallel, it is increasingly appreciated that polypharmacy poses&#xD;
        a significant challenge to our older adult population. Guthrie et al showed that the number&#xD;
        of people prescribed &gt;5 medications in an area of the UK doubled between 1995 and 2010 (from&#xD;
        11.4% to 20.8%) (4). Age is significantly associated with polypharmacy, with an odds ratio of&#xD;
        118.3 when those aged 20-29 are compared to those &gt;80. What's more, it has been estimated&#xD;
        that adverse drug reactions account for 6.5% of hospital admissions (5), with age correlating&#xD;
        significantly with admissions for this reason. Therefore, discovering a non-pharmacological&#xD;
        intervention for hypertension and cerebrovascular disease could greatly benefit the&#xD;
        population, particularly the elderly, both in terms of treating the diseases themselves and&#xD;
        reducing the harmful effects of polypharmacy.&#xD;
  &#xD;
        Remote ischaemic preconditioning (RIPC) is the induction of non-lethal ischaemia in one organ&#xD;
        or tissue, with the aim of conditioning a distant organ or tissue against ischaemic events.&#xD;
        It is achieved via inflation of a blood pressure cuff to supra-systolic pressures for a short&#xD;
        period of time. A recent meta-analysis showed that chronic RIC, but not acute RIC,&#xD;
        significantly lowered diastolic and mean arterial blood pressure (6). The studies included in&#xD;
        this review were small and performed in a younger population, hence larger studies are needed&#xD;
        to clarify the effect of RIC in the field of hypertension and, importantly, the elderly.&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Recruiting</overall_status>
    <start_date type="Actual">September 25, 2022</start_date>
    <completion_date type="Anticipated">October 31, 2024</completion_date>
    <primary_completion_date type="Anticipated">October 31, 2024</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Crossover Assignment</intervention_model>
      <intervention_model_description>Participants complete a 6-week intervention period during which the participants receive either RIPC or sham. There is then a 6-week washout period, after which participants complete the other intervention</intervention_model_description>
      <primary_purpose>Treatment</primary_purpose>
      <masking>Double (Participant, Outcomes Assessor)</masking>
      <masking_description>Participants are blinded to intervention. Assessors measuring outcomes are blinded to participant identity and intervention.</masking_description>
    </study_design_info>
    <primary_outcome>
      <measure>Clinic systolic blood pressure</measure>
      <time_frame>Measured at baseline, week 3 and week 6</time_frame>
      <description>Changes in blood pressure measured by automated sphygmomanometer over 6 weeks. Measured after participants have rested for 10 minutes in a temperature controlled room.</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>Clinic diastolic blood pressure</measure>
      <time_frame>Measured at baseline, week 3 and week 6</time_frame>
      <description>Changes in blood pressure measured by automated sphygmomanometer over 6 weeks. Measured after participants have rested for 10 minutes in a temperature controlled room.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Clinic Mean arterial pressure</measure>
      <time_frame>Measured at baseline, week 3 and week 6</time_frame>
      <description>Changes in blood pressure measured by automated sphygmomanometer over 6 weeks. Measured after participants have rested for 10 minutes in a temperature controlled room.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>24-hour systolic blood pressure</measure>
      <time_frame>Measured at baseline and week 6</time_frame>
      <description>Changes in blood pressure measured by 24-hour blood pressure monitor.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>24-hour diastolic blood pressure</measure>
      <time_frame>Measured at baseline and week 6</time_frame>
      <description>Changes in blood pressure measured by 24-hour blood pressure monitor.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>24-hour mean arterial pressure</measure>
      <time_frame>Measured at baseline and week 6</time_frame>
      <description>Changes in blood pressure measured by 24-hour blood pressure monitor.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Flow mediated dilatation (FMD)</measure>
      <time_frame>Measured at baseline, week 3 and week 6</time_frame>
      <description>Flow mediated dilatation is measured by continuous ultrasound imaging of the brachial artery. Brachial artery diameter is measured using edge tracking software for one minute before distal occlusion is applied to the brachial artery for 5 minutes at 230mmHg using and automated vascular assessment pressure cuff. Following release of the distal occlusion, flow mediated dilatation is measured for 4 minutes using edge tracking software</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Pulsewave velocity (PWV)</measure>
      <time_frame>Measured at baseline, week 3 and week 6</time_frame>
      <description>Pulsewave velocity is measured using carotid and femoral artery transducers. Pulse transit time and the distance between transducers is then used to calculate PWV.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Serum biomarkers</measure>
      <time_frame>Measured at baseline and week 6.</time_frame>
      <description>Biomarkers of RIC mechanism will be quantified by ELISA from plasma samples collected before and after intervention.</description>
    </secondary_outcome>
    <number_of_arms>2</number_of_arms>
    <enrollment type="Anticipated">60</enrollment>
    <condition>Hypertension</condition>
    <condition>Vascular Diseases</condition>
    <arm_group>
      <arm_group_label>Remote Ischaemic Preconditioning</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>RIPC is induced by 4 cycles of 5 minutes of healthy upper limb ischaemia followed by 5 minutes reperfusion. Ischaemia is induced by inflation of a blood pressure cuff to 20mmHg above systolic blood pressure. RIPC is conducted 3 times weekly for 6-weeks.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Sham remote ischaemic preconditioning</arm_group_label>
      <arm_group_type>Sham Comparator</arm_group_type>
      <description>Sham RIPC is induced by 4 cycles of 5 minutes of healthy upper limb ischaemia followed by 5 minutes reperfusion. Ischaemia is induced by inflation of a blood pressure cuff to 20mmHg. RIPC is conducted 3 times weekly for 6-weeks</description>
    </arm_group>
    <intervention>
      <intervention_type>Device</intervention_type>
      <intervention_name>Remote Ischaemic Preconditioning</intervention_name>
      <description>RIPC is induced by 4 cycles of 5 minutes of healthy upper limb ischaemia followed by 5 minutes reperfusion. Ischaemia is induced by inflation of a blood pressure cuff to 20mmHg above systolic blood pressure. RIPC is conducted 3 times weekly for 6-weeks. Clinic blood pressure is measured at weeks 0, 3 and 6. 24-hour blood pressure is measured at weeks 0 and 6.</description>
      <arm_group_label>Remote Ischaemic Preconditioning</arm_group_label>
    </intervention>
    <intervention>
      <intervention_type>Device</intervention_type>
      <intervention_name>Sham Remote Ischaemic Preconditioning</intervention_name>
      <description>Sham RIPC is induced by 4 cycles of 5 minutes of healthy upper limb ischaemia followed by 5 minutes reperfusion. Ischaemia is induced by inflation of a blood pressure cuff to 20mmHg. RIPC is conducted 3 times weekly for 6-weeks. Clinic blood pressure is measured at weeks 0, 3 and 6. 24-hour blood pressure is measured at weeks 0 and 6.</description>
      <arm_group_label>Sham remote ischaemic preconditioning</arm_group_label>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  Participant is aged &gt;65y and &lt;85y.&#xD;
  &#xD;
            -  Participant is willing and able to give informed consent for participation in the&#xD;
               study.&#xD;
  &#xD;
            -  Participant is physically able to perform RIPC.&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            -  A BMI &lt;18 or &gt;35 kg/m2&#xD;
  &#xD;
            -  Active cardiovascular, cerebrovascular or respiratory disease: e.g. uncontrolled&#xD;
               hypertension (BP &gt; 160/100), active angina, heart failure (class III/IV), arrhythmia,&#xD;
               right to left cardiac shunt, recent cardiac event, COPD, pulmonary hypertension or&#xD;
               recent (6 mo) stroke.&#xD;
  &#xD;
            -  If history of hypertension, no recent alteration to antihypertensive medication (3&#xD;
               months).&#xD;
  &#xD;
            -  A history of, or current neurological or musculoskeletal conditions (e.g. epilepsy)&#xD;
  &#xD;
            -  Having taken part in a research study in the last 3 months involving invasive&#xD;
               procedures or an inconvenience allowance&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>65 Years</minimum_age>
      <maximum_age>85 Years</maximum_age>
      <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
    </eligibility>
    <overall_official>
      <last_name>Timothy England, MB ChB PhD</last_name>
      <role>Principal Investigator</role>
      <affiliation>University of Nottingham</affiliation>
    </overall_official>
    <overall_official>
      <last_name>Bethan Phillips, PhD</last_name>
      <role>Principal Investigator</role>
      <affiliation>University of Nottingham</affiliation>
    </overall_official>
    <overall_contact>
      <last_name>Harry G Keevil, MB BChir</last_name>
      <phone>01332 724687</phone>
      <email>harry.keevil@nottingham.ac.uk</email>
    </overall_contact>
    <location>
      <facility>
        <name>School of Medicine, Royal Derby Hospital Site, University of Nottingham</name>
        <address>
          <city>Derby</city>
          <state>Derbyshire</state>
          <zip>DE22 3DT</zip>
          <country>United Kingdom</country>
        </address>
      </facility>
      <status>Recruiting</status>
      <contact>
        <last_name>Harry G Keevil, MB BChir</last_name>
        <phone>01332 724687</phone>
        <email>harry.keevil@nottingham.ac.uk</email>
      </contact>
    </location>
    <location_countries>
      <country>United Kingdom</country>
    </location_countries>
    <reference>
      <citation>Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021 Feb 23;143(8):e254-e743. doi: 10.1161/CIR.0000000000000950. Epub 2021 Jan 27.</citation>
      <PMID>33501848</PMID>
    </reference>
    <reference>
      <citation>Health matters: combating high blood pressure: Public Health England; 2017</citation>
    </reference>
    <reference>
      <citation>https://www.stroke.org.uk/what-is-stroke/stroke-statistics</citation>
    </reference>
    <reference>
      <citation>Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T. The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995-2010. BMC Med. 2015 Apr 7;13:74. doi: 10.1186/s12916-015-0322-7.</citation>
      <PMID>25889849</PMID>
    </reference>
    <reference>
      <citation>Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004 Jul 3;329(7456):15-9. doi: 10.1136/bmj.329.7456.15.</citation>
      <PMID>15231615</PMID>
    </reference>
    <reference>
      <citation>Baffour-Awuah B, Dieberg G, Pearson MJ, Smart NA. The effect of remote ischaemic conditioning on blood pressure response: A systematic review and meta-analysis. Int J Cardiol Hypertens. 2021 Feb 23;8:100081. doi: 10.1016/j.ijchy.2021.100081. eCollection 2021 Mar.</citation>
      <PMID>33748739</PMID>
    </reference>
    <verification_date>July 2023</verification_date>
    <study_first_submitted>July 4, 2023</study_first_submitted>
    <study_first_submitted_qc>July 24, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">August 2, 2023</study_first_posted>
    <last_update_submitted>July 24, 2023</last_update_submitted>
    <last_update_submitted_qc>July 24, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">August 2, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Sponsor-Investigator</responsible_party_type>
      <investigator_affiliation>University of Nottingham</investigator_affiliation>
      <investigator_full_name>Harry Keevil</investigator_full_name>
      <investigator_title>Clinical Research Fellow</investigator_title>
    </responsible_party>
    <keyword>Remote Ischaemic Preconditioning</keyword>
    <keyword>Non-pharmacological</keyword>
    <keyword>Remote Ischaemic Conditioning</keyword>
    <keyword>Randomised Controlled Trial</keyword>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Vascular Diseases</mesh_term>
    </condition_browse>
    <patient_data>
      <sharing_ipd>No</sharing_ipd>
    </patient_data>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT05971407
  org study id: FMHS 34-0722
  nct id: NCT05971407
  lead sponsor: 
  has dmc: Yes
  is fda regulated drug: No
  is fda regulated device: No
  The purpose of this study is to assess whether remote ischaemic conditioning, applied
        chronically, improves vascular health in older adults
  Hypertension and stroke remain leading causes of mortality across the world (1). Hypertension
        affects more than 1 in 4 adults and is the 3rd biggest risk factor for premature death and
        disability in the UK (2). Cerebrovascular disease is ranked 4th in the list of leading causes
        of death in the UK (3). At present, the treatment of these conditions largely involves
        chronic pharmacotherapy. In parallel, it is increasingly appreciated that polypharmacy poses
        a significant challenge to our older adult population. Guthrie et al showed that the number
        of people prescribed >5 medications in an area of the UK doubled between 1995 and 2010 (from
        11.4% to 20.8%) (4). Age is significantly associated with polypharmacy, with an odds ratio of
        118.3 when those aged 20-29 are compared to those >80. What's more, it has been estimated
        that adverse drug reactions account for 6.5% of hospital admissions (5), with age correlating
        significantly with admissions for this reason. Therefore, discovering a non-pharmacological
        intervention for hypertension and cerebrovascular disease could greatly benefit the
        population, particularly the elderly, both in terms of treating the diseases themselves and
        reducing the harmful effects of polypharmacy.
  
        Remote ischaemic preconditioning (RIPC) is the induction of non-lethal ischaemia in one organ
        or tissue, with the aim of conditioning a distant organ or tissue against ischaemic events.
        It is achieved via inflation of a blood pressure cuff to supra-systolic pressures for a short
        period of time. A recent meta-analysis showed that chronic RIC, but not acute RIC,
        significantly lowered diastolic and mean arterial blood pressure (6). The studies included in
        this review were small and performed in a younger population, hence larger studies are needed
        to clarify the effect of RIC in the field of hypertension and, importantly, the elderly.
  allocation: Randomized
  intervention model: Crossover Assignment
  intervention model description: Participants complete a 6-week intervention period during which the participants receive either RIPC or sham. There is then a 6-week washout period, after which participants complete the other intervention
  primary purpose: Treatment
  masking: Double (Participant, Outcomes Assessor)
  masking description: Participants are blinded to intervention. Assessors measuring outcomes are blinded to participant identity and intervention.
  measure: Clinic systolic blood pressure
  time frame: Measured at baseline, week 3 and week 6
  description: Changes in blood pressure measured by automated sphygmomanometer over 6 weeks. Measured after participants have rested for 10 minutes in a temperature controlled room.
  measure: Clinic diastolic blood pressure
  time frame: Measured at baseline, week 3 and week 6
  description: Changes in blood pressure measured by automated sphygmomanometer over 6 weeks. Measured after participants have rested for 10 minutes in a temperature controlled room.
  measure: Clinic Mean arterial pressure
  time frame: Measured at baseline, week 3 and week 6
  description: Changes in blood pressure measured by automated sphygmomanometer over 6 weeks. Measured after participants have rested for 10 minutes in a temperature controlled room.
  measure: 24-hour systolic blood pressure
  time frame: Measured at baseline and week 6
  description: Changes in blood pressure measured by 24-hour blood pressure monitor.
  measure: 24-hour diastolic blood pressure
  time frame: Measured at baseline and week 6
  description: Changes in blood pressure measured by 24-hour blood pressure monitor.
  measure: 24-hour mean arterial pressure
  time frame: Measured at baseline and week 6
  description: Changes in blood pressure measured by 24-hour blood pressure monitor.
  measure: Flow mediated dilatation (FMD)
  time frame: Measured at baseline, week 3 and week 6
  description: Flow mediated dilatation is measured by continuous ultrasound imaging of the brachial artery. Brachial artery diameter is measured using edge tracking software for one minute before distal occlusion is applied to the brachial artery for 5 minutes at 230mmHg using and automated vascular assessment pressure cuff. Following release of the distal occlusion, flow mediated dilatation is measured for 4 minutes using edge tracking software
  measure: Pulsewave velocity (PWV)
  time frame: Measured at baseline, week 3 and week 6
  description: Pulsewave velocity is measured using carotid and femoral artery transducers. Pulse transit time and the distance between transducers is then used to calculate PWV.
  measure: Serum biomarkers
  time frame: Measured at baseline and week 6.
  description: Biomarkers of RIC mechanism will be quantified by ELISA from plasma samples collected before and after intervention.
  arm group label: Remote Ischaemic Preconditioning
  arm group type: Active Comparator
  description: RIPC is induced by 4 cycles of 5 minutes of healthy upper limb ischaemia followed by 5 minutes reperfusion. Ischaemia is induced by inflation of a blood pressure cuff to 20mmHg above systolic blood pressure. RIPC is conducted 3 times weekly for 6-weeks.
  arm group label: Sham remote ischaemic preconditioning
  arm group type: Sham Comparator
  description: Sham RIPC is induced by 4 cycles of 5 minutes of healthy upper limb ischaemia followed by 5 minutes reperfusion. Ischaemia is induced by inflation of a blood pressure cuff to 20mmHg. RIPC is conducted 3 times weekly for 6-weeks
  intervention type: Device
  intervention name: Remote Ischaemic Preconditioning
  description: RIPC is induced by 4 cycles of 5 minutes of healthy upper limb ischaemia followed by 5 minutes reperfusion. Ischaemia is induced by inflation of a blood pressure cuff to 20mmHg above systolic blood pressure. RIPC is conducted 3 times weekly for 6-weeks. Clinic blood pressure is measured at weeks 0, 3 and 6. 24-hour blood pressure is measured at weeks 0 and 6.
  arm group label: Remote Ischaemic Preconditioning
  intervention type: Device
  intervention name: Sham Remote Ischaemic Preconditioning
  description: Sham RIPC is induced by 4 cycles of 5 minutes of healthy upper limb ischaemia followed by 5 minutes reperfusion. Ischaemia is induced by inflation of a blood pressure cuff to 20mmHg. RIPC is conducted 3 times weekly for 6-weeks. Clinic blood pressure is measured at weeks 0, 3 and 6. 24-hour blood pressure is measured at weeks 0 and 6.
  arm group label: Sham remote ischaemic preconditioning
  criteria: 
  gender: All
  minimum age: 65 Years
  maximum age: 85 Years
  healthy volunteers: Accepts Healthy Volunteers
  last name: Timothy England, MB ChB PhD
  role: Principal Investigator
  affiliation: University of Nottingham
  last name: Bethan Phillips, PhD
  role: Principal Investigator
  affiliation: University of Nottingham
  last name: Harry G Keevil, MB BChir
  phone: 01332 724687
  email: harry.keevil@nottingham.ac.uk
  facility: 
  status: Recruiting
  contact: 
  country: United Kingdom
  citation: Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021 Feb 23;143(8):e254-e743. doi: 10.1161/CIR.0000000000000950. Epub 2021 Jan 27.
  PMID: 33501848
  citation: Health matters: combating high blood pressure: Public Health England; 2017
  citation: https://www.stroke.org.uk/what-is-stroke/stroke-statistics
  citation: Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T. The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995-2010. BMC Med. 2015 Apr 7;13:74. doi: 10.1186/s12916-015-0322-7.
  PMID: 25889849
  citation: Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004 Jul 3;329(7456):15-9. doi: 10.1136/bmj.329.7456.15.
  PMID: 15231615
  citation: Baffour-Awuah B, Dieberg G, Pearson MJ, Smart NA. The effect of remote ischaemic conditioning on blood pressure response: A systematic review and meta-analysis. Int J Cardiol Hypertens. 2021 Feb 23;8:100081. doi: 10.1016/j.ijchy.2021.100081. eCollection 2021 Mar.
  PMID: 33748739
  responsible party type: Sponsor-Investigator
  investigator affiliation: University of Nottingham
  investigator full name: Harry Keevil
  investigator title: Clinical Research Fellow
  mesh term: Vascular Diseases
  sharing ipd: No