- ICH GCP
- Amerikanska kliniska prövningsregistret
- Klinisk prövning NCT01119417
The Role of Endothelin in the Supine Hypertension of Autonomic Failure
Studieöversikt
Status
Betingelser
Intervention / Behandling
Detaljerad beskrivning
The pathophysiologic mechanisms causing supine hypertension in patients with autonomic failure are not completely understood.In MSA patients, supine hypertension may be explained by residual sympathetic tone, possibly acting on hypersensitive adrenoreceptors and unstrained by the lack of baroreflex modulation. In contrast, the pathogenesis of hypertension in PAF remains unknown. Hypertension in these patients is not related to intravascular volume, residual sympathetic tone, or renin mechanisms. Increased vascular resistance is the underlying hemodynamic mechanism. The driving force of this increased vascular tone, however, is not known.
We hypothesize that endothelin (ET)-l contributes to the increased vascular resistance in pure autonomic failure patients with supine hypertension. To gauge its contribution to blood pressure regulation, we will induce endothelin blockade with acute systemic administration of BQ123 in an ascending dose regimen (25, 50, 100 and 300 nmol/min) and we will compare the hemodynamic effects between PAF and MSA patients.
Subjects will be studied on 3 different days, one with saline (placebo) and two with BQ123: a 'low dose' day (25 and 50 nmol/min infusions separated by 75 min) and a 'high dose' day (100 and 300 nmol/min infusions separated by 75 min). The order of the placebo day will be randomized in a single-blinded manner so that each subject receives it on a different visit. The order of the BQ123 study days will be always the same, starting with the low dose. If SBP drops by >40 mm Hg or SBP < 130 mm Hg during the monitoring period after the first or second infusion, the following dose(s) of BQ123 will not be given and patients will receive normal saline until the study ends.
Ganglionic Blockade with Trimethaphan (optional study day):
The purpose of this study day is to determine the level of residual sympathetic tone that contributes to supine hypertension in each autonomic failure patient by inducing transient withdrawal of the autonomic nervous system. This approach would allow us to identify patients in whom supine hypertension is not driven by sympathetic tone and thus, better characterize the role of endothelin in the hypertension of these patients.
Studietyp
Fas
- Fas 1
Kontakter och platser
Studieorter
-
-
Tennessee
-
Nashville, Tennessee, Förenta staterna, 37232
- Vanderbilt University
-
-
Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria:
- Patients with autonomic failure and supine hypertension from all races, who are in the hospital participating in the study "The Evaluation and Treatment of Autonomic Failure" (IRB# 000814).
- Supine hypertension, defined as a systolic blood pressure >150 mm Hg or diastolic blood pressure > 90 mm Hg.
- Males and females, between 18-85yr.
- Provide written informed consent to participate in the study and understand that they may withdraw their consent at any time without prejudice to their future medical care.
Exclusion Criteria:
- Pregnant women.
- High-risk patients (e.g. heart failure, symptomatic coronary artery disease, liver impairment, history of stroke or myocardial infarction).
- History of serious allergies or asthma.
- In the investigator's opinion, have clinically significant abnormalities on clinical, mental examination or laboratory testing.
- All medical students.
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Övrig
- Tilldelning: Randomiserad
- Interventionsmodell: Crossover tilldelning
- Maskning: Enda
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
---|---|
Experimentell: BQ123
endothelin blocker
|
Low dose day: 25 nmol/min, single IV infusion for 15 min.
Andra namn:
Low dose day: 50 nmol/min, single IV infusion for 15 min
Andra namn:
High dose day: 300 nmol/min, single IV infusion for 15 min.
Andra namn:
|
Placebo-jämförare: Saline
IV saline
|
2-3 IV saline infusions for 15 min each.
Andra namn:
|
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Change in Systolic BP
Tidsram: 0 -4 hr post infusion
|
Change from baseline in systolic blood pressure
|
0 -4 hr post infusion
|
Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Change in cardiac output, stroke volume and systemic vascular resistance
Tidsram: 0-4 hr post infusion
|
Percent change from baseline in hemodynamic parameters
|
0-4 hr post infusion
|
Samarbetspartners och utredare
Sponsor
Studieavstämningsdatum
Studera stora datum
Studiestart (Faktisk)
Primärt slutförande (Faktisk)
Avslutad studie (Faktisk)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Uppskatta)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Ytterligare relevanta MeSH-villkor
- Hjärt-kärlsjukdomar
- Kärlsjukdomar
- Hjärnsjukdomar
- Sjukdomar i centrala nervsystemet
- Sjukdomar i nervsystemet
- Basala ganglia sjukdomar
- Rörelsestörningar
- Synukleinopatier
- Neurodegenerativa sjukdomar
- Autonoma nervsystemets sjukdomar
- Primära dysautonomier
- Hypotoni
- Hypertoni
- Multipel systematrofi
- Shy-Drager syndrom
- Rent autonomt misslyckande
- Molekylära mekanismer för farmakologisk verkan
- Antihypertensiva medel
- Endotelinreceptorantagonister
- cyklo(Trp-Asp-Pro-Val-Leu)
Andra studie-ID-nummer
- 091344
Plan för individuella deltagardata (IPD)
Planerar du att dela individuella deltagardata (IPD)?
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