- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02472028
Blood Pressure Reduction to Limit the Evolution of Vascular Brain Lesions in Elderly Individuals (LEOPOLD)
LEukoaraiosis and blOod Pressure Reduction in OLD People
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
SCIENTIFIC BACKGROUND: White Matter Lesions (WML) are cerebrovascular abnormalities discovered on MRI that are associated with an increased risk of dementia. High blood pressure (BP) is a major risk factor for WML. WML are therefore key lesions in the causal chain linking vascular factors and dementia, particularly Alzheimer's disease.
However, it has not been shown that lowering BP could limit the progression of the WML in people with cognitive impairment.
OBJECTIVES: To test the hypothesis of slowing progression of WML by lowering BP in patients with memory complaints with a moderate to high grade of WML on brain MRI.
STUDY DESIGN: PROBE (Prospective randomized open blinded end-point) trial. Blind reading of both MRI for every patient in each group. After stratified randomization on age, sex and center, patients will be assigned to two strategies:
- Reinforced Group (RG): enhanced strategy aiming at a systolic BP <135 mmHg;
- Usual Group (UG): usual strategy based on the usual routine care.
SAMPLE SIZE: patients will be enrolled (410 in each arm) in 12 Memory Resources and Research Center (CMRR) with access to 1.5 T or more MRI.
CONDUCT OF THE STUDY:
Duration of the inclusion period: 96 months and 2 weeks. Patient participation duration: 36 months + 6 months max Total study duration: 11 years. Clinical and para-clinical evaluation: MRI as part of research at the beginning of the study and before the end of the study at 36 months + 6 months max (primary endpoint); Clinical evaluation of neuropsychological tests at the beginning of the study and yearly ; walking speed measurement single leg stance balance test ; repeated BP measurements; monitoring of neurological signs and symptoms; blood test at the beginning of the study (electrolytes, lipid profiles, fasting blood glucose, if not existing); MRI if not existing for validation of the inclusion criterion and performed in the ordinary course.
Study Type
Enrollment (Estimated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Olivier HANON, MD, PhD
- Phone Number: 33 1 44 08 35 02
- Email: olivier.hanon@brc.aphp.fr
Study Contact Backup
- Name: Christophe TZOURIO, MD, PhD
- Email: christophe.tzourio@u-bordeaux.fr
Study Locations
-
-
-
Paris, France, 75013
- Recruiting
- Memory Resources Centre and South of Ile de France Search - Broca Hospital
-
Contact:
- Olivier HANON, MD, PhD
- Phone Number: 33 1 44 08 35 02
- Email: olivier.hanon@brc.aphp.fr
-
Contact:
- Stéphanie DEBETTE, MD, PhD
- Phone Number: +33 (0) 5 57 57 16 59
- Email: stephanie.debette@isped.u-bordeaux2.fr
-
Principal Investigator:
- Olivier HANON, MD, PhD
-
-
Pellegrin Hospital Group
-
Bordeaux, Pellegrin Hospital Group, France, 33076
- Not yet recruiting
- Memory for Research and Resources Center / Neuroscience pole
-
Contact:
- Christophe Tzourio, MD, PhD
- Phone Number: +33 (0)5 57 57 16 59
- Email: christophe.tzourio@u-bordeaux.fr
-
Contact:
- Stéphanie DEBETTE, MD, PhD
- Phone Number: Tel: +33 (0) 5 57 57 16 59
- Email: stephanie.debette@isped.u-bordeaux2.fr
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- 60 to 88 years old patients;
- Patient with cognitive complaint with MMSE ≥ 20performed within 6 months prior to enrollment (with or without dementia)
- Patient with a socio-educational level ≥ 3
- Presence of hyperintensities of moderate to high grade on the last MRI or old scan (grades C and D on the modified Scheltens scale, grades 2/3 Fazekas).
- Hypertension defined by a Systolic Blood Pressure (SBP) and / or a Diastolic Blood Pressure (DBP) ≥ 140/90 mmHg, treated or not
- Affiliation to a social security system
- Informed consent given, signed consent
Exclusion Criteria:
- Presence of severe orthostatic hypotension defined as a decrease of 30 mmHg in SBP standing within 3 minutes
- Contraindication to MRI (presence of ferromagnetic foreign body (especially some intracranial clips, some heart valves, intraocular foreign bodies, metal prosthesis), subject carrying pacemaker, claustrophobic participants)
- Severe diseases associated with a life expectancy of less than 3 months;
- Major physical impairments that can interfere with the feasibility of the tests (sight, hearing ...)
- Presence of another dementia different than Alzheimer's disease vascular dementia or mixed dementia,
- Persons under guardianship;
- Secondary hypertension: renovascular hypertension, primary aldosteronism, pheochromocytoma ...;
- Patient already receiving 4 or more antihypertensive drugs at maximum dosage
- Patient participating in another clinical research study on drug requiring exclusion period
- severe renal impairment
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: blood pressure lowering algorithm
enhanced strategy aiming to reduce systolic blood pressure to <135 mmHg
|
The treatments used in the "enhanced strategy" arm are those proposed by national (HAS2013, SFHTA2013) and international (ESH 2013) recommendations, according to their Marketing Authorization and Summary of Product Characteristics : Diuretics, beta-blockers, Angiotensin Converting Enzyme inhibitors, Angiotensin Receptor Blockers, Calcium Channel Blockers Throughout the study, choice of drugs in each therapeutic class is left on the investigator's initiative.
All drugs of these classes may be used , no specific drug is tested in this study.
Other Names:
|
Active Comparator: usual strategy
usual strategy based on the usual care of routine care
|
The implementation of antihypertensive therapy the current recommendations to reach the blood pressure target in usual care.
Throughout the study, choice of drugs in each therapeutic class is left on the investigator's initiative.
Combinations of different pharmacological classes can be tested in order to find the most effective and best tolerated combinations.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
The main criterion is based on the quantitative assessment of White Matter Lesions (WML) volumes at the beginning and at the end of the study for each patient and each arm of the trial. The WML volume from the final MRI is compared to that of the initial
Time Frame: 36 months + 6 months max
|
36 months + 6 months max
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Imaging criteria : changes in the number of large or confluent WML
Time Frame: 36 months+ 6 months max
|
36 months+ 6 months max
|
Imaging criteria : changes in the volume of WML depending on their location (periventricular and deep white matter)
Time Frame: 36 months+ 6 months max
|
36 months+ 6 months max
|
Imaging criteria : changes in the number of silent infarctus
Time Frame: 36 months+ 6 months max
|
36 months+ 6 months max
|
Imaging criteria : changes in the number of microbleeds
Time Frame: 36 months+ 6 months max
|
36 months+ 6 months max
|
Imaging criteria : evolution of brain volumes (gray matter, white matter, CSF, and regional volumes including hippocampus)
Time Frame: 36 months+ 6 months max
|
36 months+ 6 months max
|
Clinical criteria: clinical criteria (changes in neuropsychological tests
Time Frame: 36 months
|
36 months
|
Clinical criteria: changes inwalking speed
Time Frame: 36 months
|
36 months
|
Clinical criteria: number of incident cases of dementia
Time Frame: 36 months
|
36 months
|
Number of incident cases of vascular events validated by an expert committee
Time Frame: 36 months
|
36 months
|
Clinical criteria: total mortality by cause
Time Frame: 36 months+ 6 months max
|
36 months+ 6 months max
|
Collaborators and Investigators
Investigators
- Study Director: Christophe TZOURIO, MD, PhD, Inserm U897 - Bordeaux University
- Principal Investigator: Olivier HANON, MD, PhD, Assistance Publique - Hôpitaux de Paris
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- P100153
- 2014 A00265-42 (Other Identifier: IDRCB)
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.
Clinical Trials on Cerebrovascular Disorders
-
Peking University Third HospitalBeijing HospitalCompletedCerebrovascular DiseasesChina
-
University Health Network, TorontoEisai Inc.CompletedDementia Associated With Cerebrovascular DiseaseCanada
-
Eisai Co., Ltd.CompletedA Study of Donepezil Hydrochloride in Patients With Dementia Associated With Cerebrovascular DiseaseDementia Associated With Cerebrovascular DiseaseKorea, Republic of
-
First Affiliated Hospital of Harbin Medical UniversityRecruitingCerebrovascular Disease Small VesselChina
-
National Taiwan University HospitalNational Science Council, TaiwanUnknown
-
National Taiwan University HospitalNational Science Council, TaiwanUnknownCerebrovascular AccidentsTaiwan
-
Chinese PLA General HospitalNot yet recruitingCardiovascular and Cerebrovascular Diseases
-
University of Alabama at BirminghamCompleted
-
MyomoUnknownCerebrovascular AccidentsUnited States
-
Chang Gung Memorial HospitalNational Science Council, Taiwan; National Health Research Institutes, TaiwanCompleted
Clinical Trials on blood pressure lowering algorithm
-
Peter GædeActive, not recruiting
-
University of AlbertaCanadian Institutes of Health Research (CIHR); Alberta Health services; Alberta...Active, not recruiting
-
Beijing Tiantan HospitalGuangzhou Red Cross Hospital; The First Dongguan Affiliated Hospital of Guangdong... and other collaboratorsRecruiting
-
Tulane UniversityBeijing Tiantan HospitalWithdrawn
-
GE HealthcareRecruiting
-
Asan Medical CenterPfizerTerminatedBrain IschemiaKorea, Republic of
-
University of AberdeenBiotechnology and Biological Sciences Research Council; Unilever R&DCompletedPrehypertensionUnited Kingdom
-
Chulalongkorn UniversityCompletedHypertension | Emergencies | Asymptomatic ConditionsThailand
-
University of ConnecticutCompleted
-
Baskent UniversityCompletedDiabetes Mellitus, Type 2Turkey