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High Blood Pressure Study at Brigham and Women's Hospital

Returning?

A A A

To see if you might qualify for the RADIANCE-HTN Clinical Study at Brigham and Women’s Hospital and to get connected directly with the research team please take the questionnaire below.

Please answer the following questions about your health and medical history. We will take all reasonable steps to protect the confidentiality of your information. You will only be asked to provide your contact information if it appears you may qualify for the study. If you do not qualify, your contact information will not be collected and your answers will be deleted. If you prefer to take the questionnaire over the phone or to learn more, please call Leah at (617) 525-9725.

Y-M-D H:M

How did you first learn about this study?

* must provide value

Please specify:

* must provide value

Your first name and last initial:

* must provide value

If you qualify and choose to participate in this study, would you be able to travel to Brigham and Women's Hospital for the procedure and 7 follow-up visits over the first year, followed by 2 annual visits? The visits would be during normal business hours (7:00A - 5:00P, Monday - Friday).

Please note: you will be reimbursed for your time and travel.

* must provide value

Yes

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What is your age?

* must provide value

Less than 18

18 - 35

36 - 45

46 - 55

56 - 65

66 - 75

76 or older

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Gender

* must provide value

Male

Female

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Are you currently pregnant, nursing, or plan to become pregnant within the next 3 years?

* must provide value

Yes

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Which of the following statements best describes your current blood pressure (BP) situation?

* must provide value

I do not take any blood pressure (BP) medications

I take 1 BP medication

I take 2 different BP medications

I take 3 + different BP medications

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Are you currently prescribed any pill that contains a diuretic (also known as a water pill/ Hydrochlorothiazide/HCT/HCTZ)?

* must provide value

Yes

Unsure

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Which blood pressure medications are you currently prescribed?

* must provide value

I am not prescribed any blood pressure medications

Ace Inhibitor (For example Lisinopril)

Beta Blocker (For example Metoprolol, Atenolol, Carvedilol)

Calcium Channel Blocker (For example Amlodipine)

ARB (For example Losartan, Valsartan)

Diuretic also known as a "water pill" (For example Hydrochlorothiazide/HCT/HCTZ, Chlorthalidone, Triamterene)

Combination pill without diuretic (for example Lotrel)

Combination pill with diuretic (For example Hyzaar, Exforge HCT, Tribenzor)

Other medication for blood pressure

What was your average systolic blood pressure (top number) while on current blood pressure medication?

* must provide value

Less than 130

130-139

140-149

150 or higher

Unsure

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What was your average diastolic blood pressure (bottom number) on current blood pressure medication?

* must provide value

Less than 80

80-89

90 or higher

Unsure

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Do you have type 1 diabetes?

* must provide value

Yes

Unsure

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Do you have type 2 diabetes?

* must provide value

Yes

I am prediabetic

Unsure

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Was your last HbA1c greater than 9.0%?

* must provide value

Yes

Unsure

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Do you have Ulcerative Colitis or Crohn's Disease?

* must provide value

Yes

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Do you have a pacemaker, ICD (Implantable Cardio-Defibrillator), or any other active implantable medical device?

* must provide value

Yes, I have a pacemaker or ICD

Yes, I have an active implantable medical device that is NOT a pacemaker or ICD (please describe below)

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Please describe your implantable medical device:

* must provide value

Does your job ever require that you work the night shift? (For example, from 11:00 PM-7:00 AM, or similar hours that require you to sleep during the daytime.)

* must provide value

Yes

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.