Cardioprotective Benefits of Carvedilol-CR or Valsartan Added to Lisinopril

Last updated: May 4, 2022
Sponsor: State University of New York at Buffalo
Overall Status: Completed

Phase

3

Condition

Stress

Vascular Diseases

Circulation Disorders

Treatment

N/A

Clinical Study ID

NCT00657241
111704
  • Ages 18-80
  • All Genders

Study Summary

14-week single blind, double baseline, forced-titration, cross-over comparison of the cardiac benefits of Coreg CR compared to valsartan added to existing ACE inhibition

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Subjects with residual (uncontrolled) hypertension on lisinopril monotherapy, definedas 24-hour ambulatory diastolic BP >85 mmHg.

Exclusion

Exclusion Criteria: A subject meeting any of the following conditions will be excluded from the study:

  • History of serious adverse effects with ACE inhibitor, Coreg, or valsartan
  • Known or suspected causes of secondary hypertension (e.g., renovascular stenosis,primary hyperaldosteronism)
  • Known ischemic heart disease requiring beta-blocker therapy (includes angina, priortransmural myocardial infarction, coronary artery bypass graft surgery or percutaneoustransluminal coronary angioplasty or stenting within 6 months prior to study entry).
  • Heart failure (NYHA Functional Class II-IV)
  • Obstructive valvular heart disease or obstructive hypertrophic cardiomyopathy
  • Presence of clinically significant ventricular or supraventricular arrhythmias (e.g.atrial fibrillation/flutter), pre-excitation syndrome, second or third degree AVblock, other conduction defects necessitating the implantation of a permanent cardiacpacemaker, or sick sinus syndrome.
  • Chronic kidney disease (serum creatinine >2.5 within past 6 months)
  • Uncontrolled diabetes mellitus (i.e., a fasting blood glucose >200 mg/dL [>11.1mmol/L] or hemoglobin A1c > 10%
  • History of alcohol or other drug abuse within 6 months prior to enrollment
  • Concomitant treatment or probable need for treatment with prohibited medications.NSAIDs, diabetes medications and other chronic meds are permitted if continuedthroughout study without dosage change.
  • Any other medical condition which renders the subject unable to complete the study orwhich would interfere with optimal participation in the study or produce a significantrisk to the subject
  • Those with persistent systolic BP elevations above 179 mmHg will be discontinued fromthe study as will those with any significant adverse effect of medication.
  • Positive pregnancy test or failure to practice adequate contraception in women ofchild-bearing potential
  • Bronchospastic asthma requiring chronic steroid or inhaler therapy
  • Any women with child-bearing potential

Study Design

Total Participants: 30
Study Start date:
April 01, 2008
Estimated Completion Date:
April 30, 2010

Study Description

Combination drug therapy is necessary for optimal blood pressure reduction and current guidelines mandate the concomitant use of ACE inhibitors and β-blockers in most patients at significant risk for cardiovascular disease (CVD) events. There is also continuing interest in combining angiotensin receptor blockers (ARBs) with ACE inhibitors in hypertension based on the unsubstantiated belief that "more complete" renin-angiotensin system inhibition is desirable. It is more attractive physiologically to combine a long-acting β-blocker with vasodilatory actions (carvedilol CR) with an ACE inhibitor because this combination addresses more directly the two fundamental hemodynamic changes needed to reduce CVD events: lowering systolic BP (afterload) and lowering heart rate; the product of the two is a reliable surrogate for reduced cardiac work. In fact, clinical trial data suggest that there is no appreciable additional BP lowering when ARBs are added to ACE inhibitors and neither class lowers heart rate. The present proposal is designed to demonstrate the superior "cardioprotection" of carvedilol CR compared to ARB (valsartan) when each is added to background ACE inhibitor therapy. Principal dependent variables include ambulatory cardiac work (24-hour mean ambulatory systolic BP x heart rate) and laboratory stress responses (central systolic time-tension indices derived from arterial tonometry pre- and post-bicycle exercise). Secondary hemodynamic variables will define changes in flow and pressure (e.g. central systolic BP and forward and reflected pressure wave estimations).

Connect with a study center

  • Erie County Medical Center

    Buffalo, New York 14215
    United States

    Site Not Available

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