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- Essai clinique NCT01691118
A Trial of Fimasartan for Early Diastolic Heart Failure (FINE)
Fimasartan for Improvement of Diastolic Dysfunction in Hypertensive Patients
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
Approximately half of hypertensive patients have diastolic dysfunction and diastolic dysfunction is associated with development of congestive heart failure and increased mortality. The Framingham study reported that 51% of patients with HF have a preserved left ventricular (LV) ejection fraction and hypertension is the strongest risk factor for HF with preserved ejection fraction, also termed diastolic heart failure. The rates of death and morbidity in these patients are as high as in patients with HF and a low LV ejection fraction. Hypertensive patients are at increased risk of developing LV hypertrophy and myocardial fibrosis, which cause relaxation abnormality and decreased compliance of LV with a rise in the LV diastolic pressure. Although HF associated with hypertension is a clinically significant problem, few clinical trials have been conducted and there is no proven pharmacological therapy to improve outcomes.
Because the activation of rennin-angiotensin-aldosterone system (RAAS) has been shown to induce LV hypertrophy and myocardial fibrosis, the RAAS may play a central role in the pathogenic process from hypertension to diastolic HF. Inhibitors of RAAS have been considered as a treatment option for these patients, and the angiotensin receptor blockers (ARB) have been of interest because they antagonize the effects of angiotensin II more completely. The largest clinical trial, the Irbesartan in Heart Failure with Preserved Systolic Function (I-PRESERVE), recently reported that treatment with irbesartan did not reduce the risk of death or hospitalization for cardiovascular causes among 4,128 patients who had HF with a preserved LV ejection fraction. The negative result observed in the I-PRESERVE trial may have been the consequence of the following possible factors. First, this trial may have targeted patients in whom the disease process was too advanced for ARBs to be effective. Second, irbesartan may not be an appropriate ARB for a HF trial, because ARBs are not all the same in terms of clinical outcome data in patients with HF. Irbesartan did not have outcome data on reducing HF hospitalization in high-risk hypertensive patients and telmisartan showed no benefits compared to placebo in these patients, although candesartan and valsartan significantly reduced endpoint in placebo-controlled trials. Telmisartan and irbesartan have PPARγ activity and this activity might neutralize the beneficial effects of ARB on HF, because it is well known that PPARγ agonist, rosiglitazone, increases the incidences of HF significantly.
Evaluating the effect of treatments on diastolic dysfunction has been limited by difficulties in non-invasive measure of LV diastolic pressure, but recent advances in echocardiography have made it possible to assess diastolic dysfunction accurately and reproducibly. Thus, additional clinical studies with the other ARBs are needed in hypertensive patients with diastolic dysfunction and assessment of diastolic function by echocardiography will be helpful to determine whether addition of ARB to standard therapy is beneficial to hypertensive patients with diastolic dysfunction. Fimasartan is the first ARB developed in Korea, and was felt to be particularly appropriate for examining the hypothesis that the ARB can improve diastolic dysfunction associated with hypertension, because fimasartan is a potent and well-tolerated ARB. To the best of our knowledge, there has been no randomized trial to demonstrate that an antihypertensive drug improves diastolic function in hypertensive patients with diastolic dysfunction. We hypothesize that fimasartan added to standard therapy will be superior to placebo in improving diastolic dysfunction in mildly symptomatic patients with hypertension and diastolic dysfunction, and try to examine this hypothesis in a double-blind, randomized comparison study using echocardiography.
Type d'étude
Inscription (Réel)
Phase
- Phase 4
Contacts et emplacements
Lieux d'étude
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Seoul, Corée, République de, 138-736
- Asan Medical Center
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- Untreated hypertension: systolic BP ≥ 140 or diastolic BP ≥ 90 mmHg or Treated hypertension
- Current heart failure symptoms with NYHA class II
- Evidence of diastolic dysfunction showing any 2 of the following:
E/E' > 10, LV posterior wall thickness > 11 mm, BNP level > 40 pg/mL
Exclusion Criteria:
- Planned cardiac surgery or planned major non-cardiac surgery within the study period
- Stroke or coronary revascularization in the past 6 months
- LV ejection fraction < 50%
- Hypertrophic or restrictive cardiomyopathy, moderate or severe valve disease, constrictive pericarditis
- Atrial fibrillation with a heart rate > 120/min
- Sitting systolic BP < 100 mmHg
- Sitting systolic BP > 160 mmHg or diastolic BP > 95 mmHg despite antihypertensive therapy
- Significant renal disease manifested by serum creatinine > 2.5 mg/dL
- Clinically significant pulmonary disease, coronary artery disease
- A diagnosis of cancer (other than superficial squamous or basal cell skin cancer) in the past 3 years or current treatment for the active cancer
- Female of child-bearing potential who do not use adequate contraception and women who are pregnant or breast-feeding
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Quadruple
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
---|---|
Comparateur actif: Fimasartan
Fimasartan 60mg qd added on conventional antihypertensive treatment for 10 months.
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Comparateur placebo: Placebo
Conventional antihypetensive treatment
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
---|---|---|
Change in E/E' ratio
Délai: 10 months
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Change in the ratio of E velocity (Early mitral inflow velocity) to E' velocity (Early mitral annular velocity) from baseline to 10 months follow-up.
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10 months
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
---|---|---|
Change in BNP levels
Délai: 10 months
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Change in BNP levels from baseline to 10 months follow-up.
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10 months
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Change in left ventricular mass
Délai: 10 months
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Change in LV mass from baseline to 10 months follow-up.
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10 months
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Change in left atrial volume
Délai: 10 months
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Change in left atrial volume from baseline to 10 months follow-up.
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10 months
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Change in global left ventricular strain
Délai: 10 months
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Change in global left ventricular strain from baseline to 10 months follow-up.
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10 months
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Change in functional class
Délai: 10 months
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Change in New York Heart Association (NYHA) functional class from baseline to 10 months follow-up.
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10 months
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Change in clinical composite
Délai: 10 months
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The clinical composite assessment is based on a change in the NYHA functional class and occurrences of serious adverse events (SAE).
Patients with an improvement in NYHA class and without SAE are classified as improved, and those as aggravated if they have SAE during treatment or report worsening of their NYHA class at the endpoint visit.
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10 months
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Collaborateurs et enquêteurs
Parrainer
Collaborateurs
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 2012-0229 (M D Anderson Cancer Center)
Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .
Essais cliniques sur Hypertension
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National Taiwan University Hospital Hsin-Chu BranchRecrutementHypertension Essentielle | Hypertension, masquéTaïwan
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University of Alabama at BirminghamTroy UniversityComplétéHypertension | Hypertension, résistante à la thérapie conventionnelle | Hypertension non contrôlée | Hypertension, blouse blancheÉtats-Unis
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Vanderbilt University Medical CenterJohns Hopkins UniversityComplétéHypertension artérielle pulmonaire | Hypertension artérielle pulmonaire idiopathique | Hypertension artérielle pulmonaire associée | Hypertension artérielle pulmonaire héréditaireÉtats-Unis
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Centre Chirurgical Marie LannelongueInconnueHypertension pulmonaire thromboembolique chronique et hypertension artérielle pulmonaireFrance
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Amsterdam UMC, location VUmcZonMw: The Netherlands Organisation for Health Research and DevelopmentInconnue
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University of Kansas Medical CenterRecrutementHypertension artérielle pulmonaire | Hypertension pulmonaire | Hypertension pulmonaire thromboembolique chronique | Hypertension pulmonaire due à une cardiopathie gauche | Hypertension pulmonaire, primaire, 4 | Hypertension pulmonaire, primaire, 2 | Hypertension pulmonaire, primaire, 3 | Hypertension... et d'autres conditionsÉtats-Unis
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Assistance Publique - Hôpitaux de ParisActif, ne recrute pasHypertension portale non cirrhotique intrahépatiqueFrance
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AstraZenecaComplétéHypertension artérielle (hypertension).
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University of MinnesotaComplétéPré hypertension | Hypertension non compliquéeÉtats-Unis
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University of South FloridaRetiréHypertension artérielle pulmonaire | Hypertension pulmonaire primitive familiale | Hypertension artérielle pulmonaire idiopathique | Hypertension pulmonaire primaireÉtats-Unis
Essais cliniques sur Fimasartan
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Boryung Pharmaceutical Co., LtdComplété
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Boryung Pharmaceutical Co., LtdSeoul National University Hospital; Kyungpook National University HospitalComplété
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Boryung Pharmaceutical Co., LtdYonsei University; Kyungpook National University HospitalComplétéL'hypertension artérielle essentielle | Insuffisance hépatiqueCorée, République de
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Boryung Pharmaceutical Co., LtdSeoul National University HospitalComplété
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Boryung Pharmaceutical Co., LtdCovanceComplétéL'hypertension artérielle essentielle
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Boryung Pharmaceutical Co., LtdChonbuk National University Hospital; Samsung Medical Center; Asan Medical Center et autres collaborateursComplétéL'hypertension artérielle essentielleCorée, République de
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Boryung Pharmaceutical Co., LtdComplétéHypertensionCorée, République de
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Seoul National University HospitalSamsung Medical Center; Chonnam National University Hospital; Korea University... et autres collaborateursInconnueSténose critique de la valve aortiqueCorée, République de
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Seoul National University Bundang HospitalComplétéHypertension | Hypertrophie ventriculaire gauche
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Boryung Pharmaceutical Co., LtdCovanceComplétéL'hypertension artérielle essentielle