Date
Item
1. Date of first intake of trial medication (dd mon yy)
date
Hospitalized at randomization
Item
2. Was the patient hospitalized at randomization?
boolean
Item
Day post randomization
integer
C0439228 (UMLS CUI [1])
Code List
Day post randomization
CL Item
Day 2 post randomization (1)
CL Item
Day 3 post randomization (2)
CL Item
Day 4 post randomization (3)
CL Item
Day 5 post randomization (4)
CL Item
Day 6 post randomization (5)
CL Item
Day 7 post randomization (6)
Systolic Blood Pressure
Item
Blood pressure (prior to morning dose of trial medications) systolic
float
Diastolic Blood Pressure
Item
Blood pressure (prior to morning dose of trial medications) diastolic
float
Pulse Rate
Item
Pulse Rate
float
If NO
Item
4. If NO please contact the patients physician by phone and try to obtain a blood pressure measurement approximately 1 week after treatment start, and complete questions 5-11.
text
Date of measurement
Item
5. Date of blood pressure measurement (dd-mon-yy)
date
C0011008 (UMLS CUI [1,1])
C0242485 (UMLS CUI [1,2])
Systolic Blood Pressure
Item
6. Blood pressure systolic after 5 minutes sitting/supine
float
C0871470 (UMLS CUI [1])
Diastolic Blood Pressure
Item
6. Blood pressure diastolic after 5 minutes sitting/supine
float
Pulse Rate
Item
7. Pulse Rate
float
C0232117 (UMLS CUI [1])
Item
8. Blood Pressure Position
integer
C1828063 (UMLS CUI [1])
Code List
8. Blood Pressure Position
Item
9. Who took patient´s blood pressure:
integer
Code List
9. Who took patient´s blood pressure:
CL Item
Physician, nurse or health care professional (1)
CL Item
Patient/Caregiver using a home blood pressure measurement device (2)
Other
Item
If "Other" specify:
text
Item
10. Source of blood pressure information:
text
Code List
10. Source of blood pressure information:
CL Item
Third party, friend or relative of patient (1)
CL Item
Patient came to study centre (2)
CL Item
Other physican or health care professional (3)
CL Item
Unable to obtain measurement (4)
Hospitalized since randomization
Item
11. Has patient been hospitalized since randomization? If YES, please complete the Hospitalization report form.
boolean