Ignite Creation Date:
2025-12-24 @ 5:43 PM
Ignite Modification Date:
2025-12-25 @ 3:11 PM
Study NCT ID:
NCT03453268
Status:
COMPLETED
Last Update Posted:
2025-07-20
First Post:
2018-01-31
Is NOT Gene Therapy:
False
Has Adverse Events:
False
Brief Title:
Impact of Reducing Antihypertensive Treatment on Mortality in Frail Subjects With Low Systolic Blood Pressure (SBP).
Sponsor:
Organization:
Raw JSON
{'hasResults': False, 'derivedSection': {'miscInfoModule': {'versionHolder': '2025-12-24'}, 'conditionBrowseModule': {'meshes': [{'id': 'D006973', 'term': 'Hypertension'}, {'id': 'D000073496', 'term': 'Frailty'}], 'ancestors': [{'id': 'D014652', 'term': 'Vascular Diseases'}, {'id': 'D002318', 'term': 'Cardiovascular Diseases'}, {'id': 'D010335', 'term': 'Pathologic Processes'}, {'id': 'D013568', 'term': 'Pathological Conditions, Signs and Symptoms'}]}}, 'protocolSection': {'designModule': {'phases': ['NA'], 'studyType': 'INTERVENTIONAL', 'designInfo': {'allocation': 'RANDOMIZED', 'maskingInfo': {'masking': 'NONE'}, 'primaryPurpose': 'OTHER', 'interventionModel': 'PARALLEL', 'interventionModelDescription': 'Therapeutic strategies: reduction of the antihypertensive treatment (intervention arm) vs. usual treatment (control arm)'}, 'enrollmentInfo': {'type': 'ACTUAL', 'count': 1048}}, 'statusModule': {'overallStatus': 'COMPLETED', 'startDateStruct': {'date': '2018-10-02', 'type': 'ACTUAL'}, 'expandedAccessInfo': {'hasExpandedAccess': False}, 'statusVerifiedDate': '2025-07', 'completionDateStruct': {'date': '2024-08-15', 'type': 'ACTUAL'}, 'lastUpdateSubmitDate': '2025-07-16', 'studyFirstSubmitDate': '2018-01-31', 'studyFirstSubmitQcDate': '2018-02-26', 'lastUpdatePostDateStruct': {'date': '2025-07-20', 'type': 'ACTUAL'}, 'studyFirstPostDateStruct': {'date': '2018-03-05', 'type': 'ACTUAL'}, 'primaryCompletionDateStruct': {'date': '2024-08-15', 'type': 'ACTUAL'}}, 'outcomesModule': {'primaryOutcomes': [{'measure': 'All-cause mortality', 'timeFrame': 'up to 48 months', 'description': 'All-cause mortality in each of the two groups during follow-up (maximum 48 months depending on when the patient was included).'}], 'secondaryOutcomes': [{'measure': 'Cause of death', 'timeFrame': 'up to 48 months', 'description': 'Occurrence of major CV events (myocardial infarction, hospitalisation for heart failure, stroke, other serious CV complication requiring specific management or hospitalisation)'}, {'measure': 'Blood pressure analysis', 'timeFrame': 'up to 48 months', 'description': 'SBP, diastolic blood pressure (DBP), pulse pressure (PP) and heart rate (HR) in the sitting position (or supine if sitting is not possible) and standing position (if possible), during the 24 to 48 month follow-up period.s'}, {'measure': 'Evaluation of frailty', 'timeFrame': 'up to 48 months', 'description': 'Frailty tests: weight, muscle strength (handgrip), Short Physical Performance Battery (SPPB) and assessment of independence using the ADL (Activities of Daily Living) scale every 6 months during the follow-up period at medical visits.'}, {'measure': 'Evaluation of cognitive function', 'timeFrame': 'up to 48 months', 'description': 'Assessment of cognitive functions by MMSE (Mini Mental State Evaluation) every six months during the follow-up period at medical visits.'}, {'measure': 'Assesment of fall and fractures', 'timeFrame': 'up to 48 months', 'description': 'Number of falls and fractures'}, {'measure': 'Medication assessment', 'timeFrame': 'up to 48 months', 'description': 'Total number of medications: number of antihypertensive medications during the 24 to 48 month follow-up period.'}, {'measure': 'Evaluation of Quality of life', 'timeFrame': 'up to 48 months', 'description': 'Quality of life scales (EQ 5D) once a year during the follow-up period at medical visits.'}, {'measure': 'Onset of cardiac decompensation', 'timeFrame': 'up to 48 months', 'description': 'Occurrence of cardiac decompensation, whether fatal or not, and monitoring of changes in blood pressure.'}, {'measure': 'Patient at high risk of decompensation', 'timeFrame': 'up to 48 months', 'description': 'Number of patients at high risk of cardiac decompensation.'}]}, 'oversightModule': {'isUsExport': False, 'oversightHasDmc': True, 'isFdaRegulatedDrug': False, 'isFdaRegulatedDevice': False}, 'conditionsModule': {'keywords': ['Blood pressure', 'Aged', 'Frailty', 'Polypharmacy'], 'conditions': ['Hypertension']}, 'referencesModule': {'references': [{'pmid': '40879421', 'type': 'DERIVED', 'citation': 'Benetos A, Gautier S, Freminet A, Metz A, Labat C, Georgiopoulos I, Bertin-Hugault F, Beuscart JB, Hanon O, Karcher P, Manckoundia P, Novella JL, Diallo A, Vicaut E, Rossignol P; RETREAT-FRAIL Study Group. Reduction of Antihypertensive Treatment in Nursing Home Residents. N Engl J Med. 2025 Nov 20;393(20):1990-2000. doi: 10.1056/NEJMoa2508157. Epub 2025 Aug 29.'}]}, 'descriptionModule': {'briefSummary': "The investigators hypothesize that a gradual reduction in antihypertensive treatment in medical-social institutions patients with low systolic blood pressure (SBP) can improve survival through a controlled increase in SBP and a decrease in secondary morbidity due to 'overmedication'.\n\nAccordingly, the investigators propose a randomized, case/control trial in NH patients ≥ 80 years with a SBP\\<130 mmHg with \\>1 anti-Htn drugs. This trial will consist of two parallel arms: the intervention arm will entail antihypertensive drug step-down, while the control arm will comprise the standard anti-hypertensive treatment.", 'detailedDescription': 'High blood pressure (BP), principally systolic hypertension, is a common condition in older people and is considered a major determinant not only of cardiovascular morbidity and mortality, but also of several other age-related diseases, including frailty, cognitive decline and loss of autonomy. The Hypertension in the Very Elderly Treatment (HYVET) study showed the beneficial effect of antihypertensive treatment in patients ≥ 80 years. More recently, the Systolic Blood Pressure Intervention Trial (SPRINT) study showed that even in subjects 75 years and older, CVD outcomes and total mortality were reduced with intensive treatment as compared to the standard therapeutic strategies. However, both HYVET and SPRINT were conducted in selected populations since they excluded the most frail subjects, those with clinically significant cognitive decline and dementia, those with several cardiovascular and other co-morbidities, as well as patients living in medical-social institutions.\n\n* Interestingly, observational studies in these frail people, have shown no or even an inverse relationship between BP and morbidity and mortality. The PARTAGE longitudinal study was performed in 1130 subjects ≥ 80 years living in medical-social institutions. These subjects were receiving at mean 7.1 drugs/day; 2/3 of them were under antihypertensive drugs (mean 2.2 drugs/day). The PARTAGE study showed an over-mortality in hypertensive subjects with low SBP (\\<130 mmHg) treated with 2 or more antihypertensive drugs. These individuals, who represented 20% of the total studied population, exhibited 80% increase in mortality compared to all other groups, even after adjustment for several comorbidities.\n* The recent European guidelines for hypertension indicate that in people ≥ 80 years with SBP≥160 mmHg there is evidence to recommend reducing SBP to between 150 and 140 mmHg. However, no recommendation exists on which strategy to follow if treatment decreases SBP to lower levels (ex: 120 mmHg) especially on the more frail and polymedicated patients of that age. Thus, in this case, physicians can either continue the same treatment of reduce the number of drugs.\n* These contrasting results in old hypertensives reflects the enormous functional heterogeneity among individual of this age-group and clearly show that functional status rather than chronological age should guide therapeutic strategies. Thus, the guidelines for robust older individuals cannot be extrapolated to very old, frail individuals, who have been completely excluded from the above-mentioned clinical trials.\n\nThe only way is to conduct a controlled clinical trial.'}, 'eligibilityModule': {'sex': 'ALL', 'stdAges': ['OLDER_ADULT'], 'minimumAge': '80 Years', 'healthyVolunteers': False, 'eligibilityCriteria': 'Inclusion Criteria:\n\n* Male and female patients aged 80 and over\n* Patients living in nursing homes\n* Patients with a SBP \\< 130 mmHg measured in Medical-Social Institutions using the connected blood pressure monitor supplied for the study (average of the last 2 out of 3 measurements after 10 min rest)\n* Hypertensive patients whose treatment contains at least 2 antihypertensive molecules and whose treatment has been stabilised for at least :\n\n * 3 weeks in the case of the introduction or discontinuation of an anti-HBP drug\n * 2 weeks in the case of a change in the dosage of one of the anti-HBP drugs.\n* Patients affiliated to a social security scheme\n* Patients who have signed the informed consent form (failing which, the legal representative)\n* Patients with dementia or with a severe reduction in physical function (impaired vision, asthenia, advanced osteoarthritis, severe tremors, etc.) and/or cognitive function may be included in this study with the agreement of their carers or family/relatives.\n\nExclusion Criteria:\n\n* Patients in whom no antihypertensive molecule can be reduced for specific reasons (heart failure with ejection fraction \\<40%, fluid retention due to heart failure, coronary artery disease and diabetic nephropathy).\n* Patients with an estimated life expectancy of \\<3 months\n* Patients who have already been included in this study or in another study at the same time'}, 'identificationModule': {'nctId': 'NCT03453268', 'acronym': 'RETREAT-FRAIL', 'briefTitle': 'Impact of Reducing Antihypertensive Treatment on Mortality in Frail Subjects With Low Systolic Blood Pressure (SBP).', 'organization': {'class': 'OTHER', 'fullName': 'Assistance Publique - Hôpitaux de Paris'}, 'officialTitle': 'Impact of Reducing Antihypertensive Treatment on Mortality in Frail Subjects With Low Systolic Blood Pressure (SBP). Multicenter, Randomized Controlled Study of Subjects Aged 80 and Over, Living in Nursing Homes and Other IMS.', 'orgStudyIdInfo': {'id': 'P160602J'}, 'secondaryIdInfos': [{'id': '2017-A01646-47', 'type': 'OTHER', 'domain': 'IDRCB'}]}, 'armsInterventionsModule': {'armGroups': [{'type': 'OTHER', 'label': '1: Interventional (drug reduction)', 'description': 'STEP DOWN strategy.\n\nProposition of reduction of the number of antihypertensive medication according to:\n\n* the systolic blood pressure levels,\n* co-morbidities', 'interventionNames': ['Other: STEP DOWN strategy']}, {'type': 'OTHER', 'label': '2: Control', 'description': 'Usual treatment', 'interventionNames': ['Other: Control']}], 'interventions': [{'name': 'STEP DOWN strategy', 'type': 'OTHER', 'description': 'reduction of the number of antihypertensive medication according to:\n\n* the systolic blood pressure levels,\n* co-morbidities', 'armGroupLabels': ['1: Interventional (drug reduction)']}, {'name': 'Control', 'type': 'OTHER', 'description': 'usual treatment', 'armGroupLabels': ['2: Control']}]}, 'contactsLocationsModule': {'locations': [{'zip': '16000', 'city': 'Angoulême', 'country': 'France', 'facility': 'CHU Angoulême (Expert center)', 'geoPoint': {'lat': 45.64997, 'lon': 0.15345}}, {'zip': '16000', 'city': 'Angoulême', 'country': 'France', 'facility': 'Font Douce (Nursing Home)', 'geoPoint': {'lat': 45.64997, 'lon': 0.15345}}, {'zip': '56400', 'city': 'Auray', 'country': 'France', 'facility': 'Keriolet (Nursing Home)', 'geoPoint': {'lat': 47.66692, 'lon': -2.98421}}, {'zip': '56400', 'city': 'Auray', 'country': 'France', 'facility': 'Kerleano (Nursing Home)', 'geoPoint': {'lat': 47.66692, 'lon': -2.98421}}, {'zip': '49240', 'city': 'Avrillé', 'country': 'France', 'facility': 'Le Parc de la Plesse (Nursing Home)', 'geoPoint': {'lat': 47.50663, 'lon': -0.58955}}, {'zip': '88240', 'city': 'Bains-les-Bains', 'country': 'France', 'facility': "Sentiers d'Automne (Nursing Home)", 'geoPoint': {'lat': 48.00113, 'lon': 6.26492}}, {'zip': '54550', 'city': 'Bainville-sur-Madon', 'country': 'France', 'facility': 'Parisot (Nursing Home)', 'geoPoint': {'lat': 48.58725, 'lon': 6.0958}}, {'zip': '10110', 'city': 'Bar-sur-Seine', 'country': 'France', 'facility': 'EHPAD du CH (Nursing Home)', 'geoPoint': {'lat': 48.11295, 'lon': 4.37656}}, {'zip': '10110', 'city': 'Bar-sur-Seine', 'country': 'France', 'facility': 'EHPAD Fontarce (Nursing Home)', 'geoPoint': {'lat': 48.11295, 'lon': 4.37656}}, {'zip': '10110', 'city': 'Bar-sur-Seine', 'country': 'France', 'facility': 'USLD du CH (Nursing Home)', 'geoPoint': {'lat': 48.11295, 'lon': 4.37656}}, {'zip': '54290', 'city': 'Bayon', 'country': 'France', 'facility': 'Saint Charles (Nursing Home)', 'geoPoint': {'lat': 48.47425, 'lon': 6.31631}}, {'zip': '64100', 'city': 'Bayonne', 'country': 'France', 'facility': 'Argia (Nursing Home)', 'geoPoint': {'lat': 43.49316, 'lon': -1.473}}, {'zip': '64100', 'city': 'Bayonne', 'country': 'France', 'facility': 'EHPAD du Prisse (Nursing home)', 'geoPoint': {'lat': 43.49316, 'lon': -1.473}}, {'zip': '64100', 'city': 'Bayonne', 'country': 'France', 'facility': 'Goxoki (Nursing Home)', 'geoPoint': {'lat': 43.49316, 'lon': -1.473}}, {'zip': '26800', 'city': 'Beauvallon', 'country': 'France', 'facility': 'EHPAD CH de Valence (Nursing home)', 'geoPoint': {'lat': 44.85593, 'lon': 4.90756}}, {'zip': '34500', 'city': 'Béziers', 'country': 'France', 'facility': 'EHPAD Simone de Beauvoir (Nursing Home)', 'geoPoint': {'lat': 43.34122, 'lon': 3.21402}}, {'zip': '34500', 'city': 'Béziers', 'country': 'France', 'facility': 'Espace Perréal (Nursing Home)', 'geoPoint': {'lat': 43.34122, 'lon': 3.21402}}, {'zip': '34500', 'city': 'Béziers', 'country': 'France', 'facility': 'USLD Espace Perréal (Nursing Home)', 'geoPoint': {'lat': 43.34122, 'lon': 3.21402}}, {'zip': '33000', 'city': 'Bordeaux', 'country': 'France', 'facility': 'CHU Bordeaux (Expert center)', 'geoPoint': {'lat': 44.84124, 'lon': -0.58046}}, {'zip': '44340', 'city': 'Bouguenais', 'country': 'France', 'facility': 'La Croix Du Gue (Nursing Home)', 'geoPoint': {'lat': 47.17941, 'lon': -1.62468}}, {'zip': '54136', 'city': 'Bouxières-aux-Dames', 'country': 'France', 'facility': 'Poincaré (Nursing Home)', 'geoPoint': {'lat': 48.75441, 'lon': 6.16294}}, {'zip': '11000', 'city': 'Carcassonne', 'country': 'France', 'facility': "Les Rives d'Ode (Nursing Home)", 'geoPoint': {'lat': 43.21649, 'lon': 2.34863}}, {'zip': '34057', 'city': 'Castelnau-le-Lez', 'country': 'France', 'facility': 'Les jardin de Sophia (Nursing Home)', 'geoPoint': {'lat': 43.63605, 'lon': 3.90137}}, {'zip': '81090', 'city': 'Castres', 'country': 'France', 'facility': 'EHPAD de Monges (Nursing Home)', 'geoPoint': {'lat': 43.60527, 'lon': 2.24088}}, {'zip': '81090', 'city': 'Castres', 'country': 'France', 'facility': 'La Villégiale Saint Jacques (Nursing Home)', 'geoPoint': {'lat': 43.60527, 'lon': 2.24088}}, {'zip': '88130', 'city': 'Charmes', 'country': 'France', 'facility': 'Saint Martin (Nursing Home)', 'geoPoint': {'lat': 48.3722, 'lon': 6.29117}}, {'zip': '88270', 'city': "Charmois-l'Orgueilleux", 'country': 'France', 'facility': 'Saint Jean (Nursing Home)', 'geoPoint': {'lat': 48.1048, 'lon': 6.26828}}, {'zip': '50100', 'city': 'Cherbourg', 'country': 'France', 'facility': 'EHPAD CH Cotentin Pasteur (Nursing Home)', 'geoPoint': {'lat': 49.63984, 'lon': -1.61636}}, {'zip': '68000', 'city': 'Colmar', 'country': 'France', 'facility': 'Centre pour Personnes Agées (Nursing Home)', 'geoPoint': {'lat': 48.08078, 'lon': 7.35584}}, {'zip': '68000', 'city': 'Colmar', 'country': 'France', 'facility': 'Diaconnat (Nursing home)', 'geoPoint': {'lat': 48.08078, 'lon': 7.35584}}, {'zip': '93470', 'city': 'Coubron', 'country': 'France', 'facility': 'Chantereine-Orpea (Nursing Home)', 'geoPoint': {'lat': 48.91667, 'lon': 2.58333}}, {'zip': '40088', 'city': 'Dax', 'country': 'France', 'facility': 'Le Hameau de Saubagnacq (Nursing Home)', 'geoPoint': {'lat': 43.71032, 'lon': -1.05366}}, {'zip': '21000', 'city': 'Dijon', 'country': 'France', 'facility': 'CHU Dijon (Expert center)', 'geoPoint': {'lat': 47.31344, 'lon': 5.01391}}, {'zip': '21000', 'city': 'Dijon', 'country': 'France', 'facility': 'EHPAD CHU Dijon Bourgogne (Nursing Home)', 'geoPoint': {'lat': 47.31344, 'lon': 5.01391}}, {'zip': '21000', 'city': 'Dijon', 'country': 'France', 'facility': 'Les Bégonias (Nursing Home)', 'geoPoint': {'lat': 47.31344, 'lon': 5.01391}}, {'zip': '21000', 'city': 'Dijon', 'country': 'France', 'facility': 'Les marguerites (Nursing Home)', 'geoPoint': {'lat': 47.31344, 'lon': 5.01391}}, {'zip': '21000', 'city': 'Dijon', 'country': 'France', 'facility': 'Port du Canal (Nursing Home)', 'geoPoint': {'lat': 47.31344, 'lon': 5.01391}}, {'zip': '95600', 'city': 'Eaubonne', 'country': 'France', 'facility': 'EHPAD Simone Veil (Nursing Home)', 'geoPoint': {'lat': 48.99712, 'lon': 2.28249}}, {'zip': '54270', 'city': 'Essey-lès-Nancy', 'country': 'France', 'facility': 'Bas-Château (Nursing Home)', 'geoPoint': {'lat': 48.705, 'lon': 6.22691}}, {'zip': '21121', 'city': 'Fontaine-lès-Dijon', 'country': 'France', 'facility': 'Belfontaine (Nursing Home)', 'geoPoint': {'lat': 47.34238, 'lon': 5.02007}}, {'zip': '88640', 'city': 'Granges-sur-Vologne', 'country': 'France', 'facility': 'Accueil Vologne (Nursing Home)', 'geoPoint': {'lat': 48.14517, 'lon': 6.79095}}, {'zip': '44290', 'city': 'Guémené-Penfao', 'country': 'France', 'facility': 'Vallée Don (Nursing Home)', 'geoPoint': {'lat': 47.63043, 'lon': -1.8327}}, {'zip': '42350', 'city': 'La Talaudière', 'country': 'France', 'facility': 'EHPAD Orpéa (Nursing home)', 'geoPoint': {'lat': 45.47603, 'lon': 4.42607}}, {'zip': '54690', 'city': 'Lay-Saint-Christophe', 'country': 'France', 'facility': 'Baudinet De Courcelles (Nursing home)', 'geoPoint': {'lat': 48.74926, 'lon': 6.19735}}, {'zip': '59000', 'city': 'Lille', 'country': 'France', 'facility': 'CHU Lille (Expert center)', 'geoPoint': {'lat': 50.63391, 'lon': 3.05512}}, {'zip': '59000', 'city': 'Lille', 'country': 'France', 'facility': 'Les Bateliers (Nursing Home)', 'geoPoint': {'lat': 50.63391, 'lon': 3.05512}}, {'zip': '59000', 'city': 'Lille', 'country': 'France', 'facility': 'Saint Antoine de Padoue (Nursing Home)', 'geoPoint': {'lat': 50.63391, 'lon': 3.05512}}, {'zip': '33310', 'city': 'Lormont', 'country': 'France', 'facility': 'EHPAD de Lormont (Nursing Home)', 'geoPoint': {'lat': 44.8765, 'lon': -0.51919}}, {'zip': '54710', 'city': 'Ludres', 'country': 'France', 'facility': 'Sainte Thérèse (Nursing Home)', 'geoPoint': {'lat': 48.62032, 'lon': 6.16747}}, {'zip': '54300', 'city': 'Lunéville', 'country': 'France', 'facility': 'Saint Charles (Nursing Home)', 'geoPoint': {'lat': 48.59273, 'lon': 6.49383}}, {'zip': '69000', 'city': 'Lyon', 'country': 'France', 'facility': 'CHU Lyon (Expert center)', 'geoPoint': {'lat': 45.74906, 'lon': 4.84789}}, {'zip': '69000', 'city': 'Lyon', 'country': 'France', 'facility': 'EHPAD Constant (Nursing Home)', 'geoPoint': {'lat': 45.74906, 'lon': 4.84789}}, {'zip': '13000', 'city': 'Marseille', 'country': 'France', 'facility': 'La Renaissance-Orpea (Nursing Home)', 'geoPoint': {'lat': 43.29695, 'lon': 5.38107}}, {'zip': '54320', 'city': 'Maxéville', 'country': 'France', 'facility': 'Bon repos (Nursing Home)', 'geoPoint': {'lat': 48.71324, 'lon': 6.16658}}, {'zip': '54320', 'city': 'Maxéville', 'country': 'France', 'facility': 'Saint Sauveur (Nursing Home)', 'geoPoint': {'lat': 48.71324, 'lon': 6.16658}}, {'zip': '57000', 'city': 'Metz', 'country': 'France', 'facility': 'Félix Marechal (Nursing Home)', 'geoPoint': {'lat': 49.11911, 'lon': 6.17269}}, {'zip': '40192', 'city': 'Mont-de-Marsan', 'country': 'France', 'facility': 'USLD Nouvielle (Nursing Home)', 'geoPoint': {'lat': 43.89022, 'lon': -0.49713}}, {'zip': '78428', 'city': 'Montmorency', 'country': 'France', 'facility': 'Coteaux de Montmorency (Nursing Home)', 'geoPoint': {'lat': 48.98826, 'lon': 2.3434}}, {'zip': '78428', 'city': 'Montmorency', 'country': 'France', 'facility': 'Jeanne Callarec (Nursing Home)', 'geoPoint': {'lat': 48.98826, 'lon': 2.3434}}, {'zip': '34000', 'city': 'Montpellier', 'country': 'France', 'facility': 'Antonin Balmès (Nursing Home)', 'geoPoint': {'lat': 43.61093, 'lon': 3.87635}}, {'zip': '34000', 'city': 'Montpellier', 'country': 'France', 'facility': 'CHU Montpellier (Expert center)', 'geoPoint': {'lat': 43.61093, 'lon': 3.87635}}, {'zip': '34000', 'city': 'Montpellier', 'country': 'France', 'facility': 'CSPA Bellevue (Nursing Home)', 'geoPoint': {'lat': 43.61093, 'lon': 3.87635}}, {'zip': '31600', 'city': 'Muret', 'country': 'France', 'facility': 'EHPAD du CH (Nursing Home)', 'geoPoint': {'lat': 43.45998, 'lon': 1.32541}}, {'zip': '54000', 'city': 'Nancy', 'country': 'France', 'facility': 'Les Cygnes (Nursing Home)', 'geoPoint': {'lat': 48.68439, 'lon': 6.18496}}, {'zip': '54000', 'city': 'Nancy', 'country': 'France', 'facility': 'Notre Maison (Nursing home)', 'geoPoint': {'lat': 48.68439, 'lon': 6.18496}}, {'zip': '54000', 'city': 'Nancy', 'country': 'France', 'facility': 'Saint Charles EHPAD (Nursing Home)', 'geoPoint': {'lat': 48.68439, 'lon': 6.18496}}, {'zip': '54000', 'city': 'Nancy', 'country': 'France', 'facility': 'Saint Charles USLD (Nursing Home)', 'geoPoint': {'lat': 48.68439, 'lon': 6.18496}}, {'zip': '54000', 'city': 'Nancy', 'country': 'France', 'facility': 'Saint Joseph (Nursing Home)', 'geoPoint': {'lat': 48.68439, 'lon': 6.18496}}, {'zip': '54000', 'city': 'Nancy', 'country': 'France', 'facility': 'Saint Stanislas (Nursing Home)', 'geoPoint': {'lat': 48.68439, 'lon': 6.18496}}, {'zip': '54500', 'city': 'Nancy', 'country': 'France', 'facility': 'Gériatrie - CHRU de Nancy (Expert center)', 'geoPoint': {'lat': 48.68439, 'lon': 6.18496}}, {'zip': '44000', 'city': 'Nantes', 'country': 'France', 'facility': 'Beauséjour (Nursing Home)', 'geoPoint': {'lat': 47.21725, 'lon': -1.55336}}, {'zip': '44000', 'city': 'Nantes', 'country': 'France', 'facility': 'CHU Nantes (Expert center)', 'geoPoint': {'lat': 47.21725, 'lon': -1.55336}}, {'zip': '44000', 'city': 'Nantes', 'country': 'France', 'facility': 'La Chézalière LNA Santé (Nursing Home)', 'geoPoint': {'lat': 47.21725, 'lon': -1.55336}}, {'zip': '06000', 'city': 'Nice', 'country': 'France', 'facility': 'CHU Nice (Expert center)', 'geoPoint': {'lat': 43.70313, 'lon': 7.26608}}, {'zip': '06000', 'city': 'Nice', 'country': 'France', 'facility': 'EHPAD Cimiez du CHU (Nursing Home)', 'geoPoint': {'lat': 43.70313, 'lon': 7.26608}}, {'zip': '10400', 'city': 'Nogent-sur-Seine', 'country': 'France', 'facility': 'EHPAD GHAM (Nursing Home)', 'geoPoint': {'lat': 48.49372, 'lon': 3.50262}}, {'zip': '67205', 'city': 'Oberhausbergen', 'country': 'France', 'facility': 'Bethel (Nursing Home)', 'geoPoint': {'lat': 48.60607, 'lon': 7.68846}}, {'zip': '85340', 'city': 'Olonne-sur-Mer', 'country': 'France', 'facility': "Les Jardins d'Olonne 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