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出境医 / 临床实验 / Clinical Efficacy of Telmisartan in Reducing Cardiac Remodeling Among Obese Patients With Hypertension

Clinical Efficacy of Telmisartan in Reducing Cardiac Remodeling Among Obese Patients With Hypertension

Study Description
Brief Summary:
Hypertension is closely related to metabolic abnormalities such as obesity, dyslipidemia and diabetes. When hypertension is complicated with metabolic abnormalities, target organ damage is more serious, the risk of cardiovascular adverse events is greater, and the treatment is more complex. The pathophysiological mechanism of obesity-associated hypertension has its particularity. Blood pressure control and effective control of obesity are important therapeutic targets. At present, there are no guidelines for the treatment of obesity-associated hypertension. Although several drugs have certain effects on fat metabolism, they have little effect on blood pressure and have some side effects in long-term use. Among the existing antihypertensive drugs, angiotensin II type 1 receptor (AT-1) antagonists have shown their particularity in improving glycolipid metabolism, but strict clinical trials are needed to confirm their effectiveness in weight loss and metabolism improvement. Previous studies have shown that obese patients with hypertension have severe insulin resistance, poor glycolipid metabolism and are prone to cardiovascular damage. Telmisartan can block AT-1 receptor and partially activate PPAR-γ, increase the expression of PPAR-γ target gene in preadipocytes, improve the function of visceral adipose tissue, and effectively prevent obesity-related cardiovascular diseases. It is presumed that telmisartan can act as a PPAR-γ agonist in clinic by altering the metabolic components and insulin sensitivity, but there is no clinical evidence for this. On the basis of previous studies, this study aims to evaluate the clinical efficacy of telmisartan or amlodipine in controlling blood pressure, reducing fat accumulation, improving insulin sensitivity, and reducing cardiac remodeling in obese patients with hypertension by prospective cohort study.

Condition or disease Intervention/treatment Phase
Hypertension Drug: telmisartan Drug: amlodipine Not Applicable

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Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 300 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: A Cohort Study of Telmisartan on Metabolic Components and Left Ventricular Remodeling in Obese Patients With Hypertension
Actual Study Start Date : August 1, 2019
Estimated Primary Completion Date : May 1, 2021
Estimated Study Completion Date : December 1, 2021
Arms and Interventions
Arm Intervention/treatment
Experimental: Telmisartan
generic name:telmisartan;dosage form:80 mg;dosage:80 mg;frequency:once a day;duration:June , 2019-June , 2021
Drug: telmisartan
Telmisartan group: telmisartan 80 mg once a day

Active Comparator: Amlodipine
generic name: amlodipine;dosage form:5mg;dosage:5mg;frequency:once a day;duration:June , 2019-June , 2021
Drug: amlodipine
amlodipine group: amlodipine 5 mg once a day

Outcome Measures
Primary Outcome Measures :
  1. Revascularization for myocardial infarction and unstable angina pectoris [ Time Frame: From date of randomization until the date of first documented progression,assessed up to 24 months ]
    Revascularization for myocardial infarction and unstable angina pectoris

  2. Heart failure [ Time Frame: From date of randomization until the date of first documented progression,assessed up to 24 months ]
    Heart failure

  3. stroke [ Time Frame: From date of randomization until the date of first documented progression,assessed up to 24 months ]
    stroke


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years to 79 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Essential hypertension patients (including those with unconventional diagnosed hypertension, whose average blood pressure was more than 160 or/and 100 mmHg in two outpatient follow-up visits; or those who were undergoing combined antihypertensive therapy; or those whose blood pressure control was unsatisfactory and whose blood pressure was more than 140 or/and 90 mmHg in single drug treatment);
  • The age ranged from 18 to 79 years;
  • Body mass index, BMI (≥ 30 kg/m2), or waist circumference, male (≥102 cm), female (≥88 cm);
  • Ability to provide informed consent.

Exclusion Criteria:

  • Secondary hypertension;
  • Acute cardiovascular and cerebrovascular events occurred within 3 months;
  • Complicated with severe cardiomyopathy, rheumatic heart disease, congenital heart disease;
  • unstable angina pectoris;
  • Severe liver or kidney diseases (ALT increased twice; creatinine > 2.5 mg/d1);
  • Tumor;
  • Gout;
  • Women who are taking contraceptives or are at risk of pregnancy; -Has a history of allergy to research drugs;
  • Those who have clear contraindications to the research drugs;
  • Those who are participating in other clinical trials;
  • Those who are not easy to follow up for a long time or have poor compliance;
  • Doctors in charge do not consider it advisable to participate in clinical research.
Contacts and Locations

Contacts
Layout table for location contacts
Contact: Gang Tian, doctor 0086-18991232420 tiangang@xjtu.edu.cn
Contact: Lifei Cao, master 0086-15829315817 caolifei1187@stu.xjtu.edu.cn

Locations
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China, Shanxi
First Affiliated Hospital of Xi'an Jiaotong University Recruiting
Xi'an, Shanxi, China, 710061
Contact: Gang Tian, doctor    0086-18991232420    tiangang@xjtu.edu.cn   
Contact: Lifei Cao, master    0086-15829315817    caolifei1187@stu.xjtu.edu.cn   
Sponsors and Collaborators
First Affiliated Hospital Xi'an Jiaotong University
Investigators
Layout table for investigator information
Principal Investigator: Gang Tian, doctor First Affiliated Hospital Xi'an Jiaotong University
Tracking Information
First Submitted Date  ICMJE May 4, 2019
First Posted Date  ICMJE May 21, 2019
Last Update Posted Date August 8, 2019
Actual Study Start Date  ICMJE August 1, 2019
Estimated Primary Completion Date May 1, 2021   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: May 21, 2019)
  • Revascularization for myocardial infarction and unstable angina pectoris [ Time Frame: From date of randomization until the date of first documented progression,assessed up to 24 months ]
    Revascularization for myocardial infarction and unstable angina pectoris
  • Heart failure [ Time Frame: From date of randomization until the date of first documented progression,assessed up to 24 months ]
    Heart failure
  • stroke [ Time Frame: From date of randomization until the date of first documented progression,assessed up to 24 months ]
    stroke
Original Primary Outcome Measures  ICMJE
 (submitted: May 16, 2019)
  • Revascularization for myocardial infarction and unstable angina pectoris [ Time Frame: From date of randomization until the date of first documented progression,assessed up to 24 months ]
  • Heart failure [ Time Frame: From date of randomization until the date of first documented progression,assessed up to 24 months ]
  • stroke [ Time Frame: From date of randomization until the date of first documented progression,assessed up to 24 months ]
Change History
Current Secondary Outcome Measures  ICMJE Not Provided
Original Secondary Outcome Measures  ICMJE Not Provided
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Clinical Efficacy of Telmisartan in Reducing Cardiac Remodeling Among Obese Patients With Hypertension
Official Title  ICMJE A Cohort Study of Telmisartan on Metabolic Components and Left Ventricular Remodeling in Obese Patients With Hypertension
Brief Summary Hypertension is closely related to metabolic abnormalities such as obesity, dyslipidemia and diabetes. When hypertension is complicated with metabolic abnormalities, target organ damage is more serious, the risk of cardiovascular adverse events is greater, and the treatment is more complex. The pathophysiological mechanism of obesity-associated hypertension has its particularity. Blood pressure control and effective control of obesity are important therapeutic targets. At present, there are no guidelines for the treatment of obesity-associated hypertension. Although several drugs have certain effects on fat metabolism, they have little effect on blood pressure and have some side effects in long-term use. Among the existing antihypertensive drugs, angiotensin II type 1 receptor (AT-1) antagonists have shown their particularity in improving glycolipid metabolism, but strict clinical trials are needed to confirm their effectiveness in weight loss and metabolism improvement. Previous studies have shown that obese patients with hypertension have severe insulin resistance, poor glycolipid metabolism and are prone to cardiovascular damage. Telmisartan can block AT-1 receptor and partially activate PPAR-γ, increase the expression of PPAR-γ target gene in preadipocytes, improve the function of visceral adipose tissue, and effectively prevent obesity-related cardiovascular diseases. It is presumed that telmisartan can act as a PPAR-γ agonist in clinic by altering the metabolic components and insulin sensitivity, but there is no clinical evidence for this. On the basis of previous studies, this study aims to evaluate the clinical efficacy of telmisartan or amlodipine in controlling blood pressure, reducing fat accumulation, improving insulin sensitivity, and reducing cardiac remodeling in obese patients with hypertension by prospective cohort study.
Detailed Description

At present, there are no guidelines for the treatment of obese patients with hypertension. Blood pressure control and effective control of obesity are important therapeutic targets for obesity-associated hypertension. Whether telmisartan can be used as PPAR-γ agonist, unlike other AT-1 receptor antagonists and calcium channel blockers amlodipine, can improve the visceral adipose tissue function and cardiac remodeling in obese patients with hypertension by altering their metabolic components and insulin sensitivity while controlling blood pressure. There is no evidence that telmisartan can reduce cardiac remodeling in obese patients with hypertension.

1.Research contents:

  1. To evaluate the clinical efficacy of telmisartan or amlodipine in controlling blood pressure, reducing fat accumulation, improving glycolipid metabolism and insulin sensitivity, and reducing cardiac remodeling in obese patients with hypertension;
  2. To evaluate whether telmisartan can alter metabolic components and insulin sensitivity, improve visceral adipose tissue function and reduce cardiac remodeling in obese patients with hypertension by blocking AT-1 receptor and partially activating PPAR-gamma, which is different from other AT-1 receptor antagonists and calcium channel blockers amlodipine.

2.Research population 2.1 Entry criteria

Only those who possess the following four conditions can enter the study:

  1. Essential hypertension patients (including confirmed hypertension without regular treatment, average blood pressure (≥160 or/and 100 mmHg) in two follow-up visits; or hypertension under combined antihypertensive treatment; or unsatisfactory blood pressure control with single drug treatment, blood pressure above 140 or/and 90 mmHg);
  2. Age ranges from 18 to 79;
  3. Body mass index, BMI (≥30 kg/m2), or waist circumference, male (≥102 cm), female (≥ 88 cm);
  4. Ability to provide informed consent。

2.2 exclusion criteria

One of the following is not included:

(1) secondary hypertension; (2) acute cardiovascular and cerebrovascular events within 3 months; (3) severe cardiomyopathy, rheumatic heart disease, congenital heart disease;(4) unstable angina pectoris; (5) severe liver or kidney disease (ALT increased by 2 times; Creatinine > 2. 5 mg/dL); (6) malignant tumors; (7) gout; (8) women who are taking birth control pills or are at risk of pregnancy; (9) have a history of allergy to research drugs; (10) patients with specific contraindications to the study drugs; (11) participants in other clinical trials; (12) patients with difficulty in long-term follow-up or poor compliance; (13) the competent doctor considers it inappropriate to participate in clinical research.

3.The input information of the subjects

  1. Sample source: Since December 2018, patients with essential hypertension were diagnosed in the First Affiliated Hospital of Xi'an Jiaotong University and treated with telmisartan or amlodipine alone under the guidance of doctors;
  2. Recruitment procedures: selecting the subjects according to inclusion and exclusion criteria, and signing informed consent.

4.Criteria for termination or withdrawal of research subjects

  1. Those who need revascularization because of myocardial infarction and unstable angina pectoris;
  2. Heart failure;
  3. Stroke.

5. Study Groups

  1. Telmisartan group: Telmisartan 80 mg once a day
  2. amlodipine group: amlodipine 5 mg once a day

6.Research evaluation index

  1. Baseline indicators: age, sex, occupation, height, weight, BMI, waist-hip circumference, systolic blood pressure, diastolic blood pressure, heart rate;
  2. Metabolic indicators: blood lipid, liver function, kidney function, oral glucose tolerance test, simultaneous insulin release test, plasma Glucagon, plasma aldosterone, plasma angiotensin II, abdominal fat distribution
  3. Fat function: serum leptin, serum adiponectin, serum TNFalpha, serum IL-6, serum hs-CRP, serum PPAR-γ;
  4. Cardiac remodeling: echocardiographic parameters .

7.Research steps

  1. Clinical trials are ethically reviewed by ethics committees, and clinical trials are registered;
  2. Collect cases according to inclusion and exclusion criteria, collect medical history data of subjects, and complete follow-up. At the same time, clinical and biochemical experiments were carried out;
  3. Comprehensive analysis of experimental data, repetition and supplementation of necessary molecular biological experiments, comprehensive summary of the results, writing and publishing SCI papers and Chinese core journal papers.
Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Condition  ICMJE Hypertension
Intervention  ICMJE
  • Drug: telmisartan
    Telmisartan group: telmisartan 80 mg once a day
  • Drug: amlodipine
    amlodipine group: amlodipine 5 mg once a day
Study Arms  ICMJE
  • Experimental: Telmisartan
    generic name:telmisartan;dosage form:80 mg;dosage:80 mg;frequency:once a day;duration:June , 2019-June , 2021
    Intervention: Drug: telmisartan
  • Active Comparator: Amlodipine
    generic name: amlodipine;dosage form:5mg;dosage:5mg;frequency:once a day;duration:June , 2019-June , 2021
    Intervention: Drug: amlodipine
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Recruiting
Estimated Enrollment  ICMJE
 (submitted: May 16, 2019)
300
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE December 1, 2021
Estimated Primary Completion Date May 1, 2021   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Essential hypertension patients (including those with unconventional diagnosed hypertension, whose average blood pressure was more than 160 or/and 100 mmHg in two outpatient follow-up visits; or those who were undergoing combined antihypertensive therapy; or those whose blood pressure control was unsatisfactory and whose blood pressure was more than 140 or/and 90 mmHg in single drug treatment);
  • The age ranged from 18 to 79 years;
  • Body mass index, BMI (≥ 30 kg/m2), or waist circumference, male (≥102 cm), female (≥88 cm);
  • Ability to provide informed consent.

Exclusion Criteria:

  • Secondary hypertension;
  • Acute cardiovascular and cerebrovascular events occurred within 3 months;
  • Complicated with severe cardiomyopathy, rheumatic heart disease, congenital heart disease;
  • unstable angina pectoris;
  • Severe liver or kidney diseases (ALT increased twice; creatinine > 2.5 mg/d1);
  • Tumor;
  • Gout;
  • Women who are taking contraceptives or are at risk of pregnancy; -Has a history of allergy to research drugs;
  • Those who have clear contraindications to the research drugs;
  • Those who are participating in other clinical trials;
  • Those who are not easy to follow up for a long time or have poor compliance;
  • Doctors in charge do not consider it advisable to participate in clinical research.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 79 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Gang Tian, doctor 0086-18991232420 tiangang@xjtu.edu.cn
Contact: Lifei Cao, master 0086-15829315817 caolifei1187@stu.xjtu.edu.cn
Listed Location Countries  ICMJE China
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03956823
Other Study ID Numbers  ICMJE XJTU1AF-CRF-2018-005
Has Data Monitoring Committee No
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party First Affiliated Hospital Xi'an Jiaotong University
Study Sponsor  ICMJE First Affiliated Hospital Xi'an Jiaotong University
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Gang Tian, doctor First Affiliated Hospital Xi'an Jiaotong University
PRS Account First Affiliated Hospital Xi'an Jiaotong University
Verification Date August 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP