- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00248807
A Study of Blood Pressure and Blood Supply to the Brain in Persons With a Spinal Cord Injury.
Systemic Hemodynamics and Cerebral Blood Flow in Persons With Tetraplegia
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Individuals with tetraplegia lack normal sympathetic nervous system regulation of blood pressure and, therefore, relative hypotension is a common occurrence. This hypotension may be more pronounced with postural stress. Loss in mental acuity and sometimes even consciousness is an associated symptom of postural hypotension in individuals with tetraplegia.
There is some evidence to suggest that although mean arterial blood pressure (MAP) is relatively low in these individuals, middle cerebral arterial blood flow (CBF) may be maintained. Consequently, individuals with chronic tetraplegia often compensate and are stable in the seated upright position.
Autoregulation of CBF has been defined as the stability of cerebral blood flow throughout a range of systemic blood pressures (MAP). This proposal will examine systemic hemodynamics and middle cerebral artery blood flow during HUT with and without Vasotec, an angiotensin II inhibitor. By partially or completely ablating the renin-angiotensin system, which is postulated to play a major role in blood pressure regulation, the potential dissociation between systemic blood pressure and middle cerebral artery blood flow, in individuals with tetraplegia, may be demonstrated. The aim is to determine whether persons with chronic tetraplegia are able to maintain similar CBF, or similar CBF changes, as able-bodied controls despite a greater decrease in MAP to the same hypotensive challenge. The relationship between MAP and CBF has not been defined in this population. Understanding this relationship may lead to improved screening and treatment for prevention of postural hypotension in persons with tetraplegia.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
New York
-
Bronx, New York, United States, 10468
- VA Medical Center, Bronx
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Duration of spinal cord injury (SCI) at least 1 year
- Level of SCI C4-8 and T6 and below
- matched non-SCI subjects
- Chronological age between 18-65 years
- Euhydration: Subjects will be instructed to avoid caffeine and alcohol and to maintain normal salt and water intake for several days prior to study.
Exclusion Criteria:
- Known heart and/or blood vessel disease
- Dehydration
- High blood pressure
- Kidney disease
- Diabetes mellitus
- Prescribed ACE inhibitors
- Acute Infection
- Smoking
- Pregnancy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: ARM 1
Head-up tilt maneuver without drug in subjects with spinal cord injury
|
45 degree head-up tilt to lower blood pressure and measure cerebral blood flow.
|
Placebo Comparator: ARM 3
Head-up tilt maneuver without drug in able-bodied controls
|
45 degree head-up tilt to lower blood pressure and measure cerebral blood flow.
|
Active Comparator: ARM 2
Head-up tilt maneuver with an angiotensin converting enzyme inhibitor (1.25 mg enalaprilat) in subjects with spinal cord injury
|
45 degree head-up tilt to lower blood pressure and measure cerebral blood flow.
an angiotensin converting enzyme (ACE) inhibitor given to lower blood pressure (BP) and measure cerebral blood flow (CBF)
|
Active Comparator: ARM 4
Head-up tilt maneuver with an angiotensin converting enzyme inhibitor (1.25 mg enalaprilat) in able-bodied controls.
|
45 degree head-up tilt to lower blood pressure and measure cerebral blood flow.
an angiotensin converting enzyme (ACE) inhibitor given to lower blood pressure (BP) and measure cerebral blood flow (CBF)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Systolic Blood Pressure
Time Frame: acute testing
|
Systolic blood pressure during head-up tilt in subjects with spinal cord injury without drug intervention
|
acute testing
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cerebral Blood Flow
Time Frame: acute testing
|
Measurement of middle cerebral artery blood flow velocity supine and during head-up tilt
|
acute testing
|
Collaborators and Investigators
Investigators
- Principal Investigator: Jill Wecht, EdD, VA Medical Center, Bronx
Publications and helpful links
General Publications
- Handrakis JP, DeMeersman RE, Rosado-Rivera D, LaFountaine MF, Spungen AM, Bauman WA, Wecht JM. Effect of hypotensive challenge on systemic hemodynamics and cerebral blood flow in persons with tetraplegia. Clin Auton Res. 2009 Feb;19(1):39-45. doi: 10.1007/s10286-008-0496-6. Epub 2008 Oct 11.
- Wecht JM, Rosado-Rivera D, Jegede A, Cirnigliaro CM, Jensen MA, Kirshblum S, Bauman WA. Systemic and cerebral hemodynamics during cognitive testing. Clin Auton Res. 2012 Feb;22(1):25-33. doi: 10.1007/s10286-011-0139-1. Epub 2011 Jul 27.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Wounds and Injuries
- Trauma, Nervous System
- Spinal Cord Diseases
- Autonomic Nervous System Diseases
- Primary Dysautonomias
- Orthostatic Intolerance
- Hypotension
- Spinal Cord Injuries
- Hypotension, Orthostatic
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Enzyme Inhibitors
- Protease Inhibitors
- Angiotensin-Converting Enzyme Inhibitors
- Enalaprilat
- Enalapril
Other Study ID Numbers
- B3346-V
- 00517 (Other Identifier: JJP VAMC IRB)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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