ASTRIDE: Aliskiren HCTZ Compared to Amlodipine in Patients With Stage 2 Systolic Hypertension and Diabetes Mellitus

• Sponsor: Novartis (Industry)
• Overall Status: Completed
• CT.gov ID: NCT00787605
• Collaborator: (none)
• Enrollment: 860
• Location: 1
• Arms: 2
• Duration (Months): 14
• Patients Per Site Per Month: 61.4

Study Details

Study Description

Brief Summary

The purpose of the study is to evaluate the blood pressure lowering effect and safety of aliskiren in combination with Hydrochlorothiazide (HCTZ) given to diabetic patients with stage 2 systolic hypertension (mean sitting systolic blood pressure (msSBP) ≥ 160 mm Hg and < 200 mm Hg).

Condition or Disease	Intervention/Treatment	Phase
Hypertension; Diabetes Mellitus	Drug: Amlodipine; Drug: Hydrochlorothiazide (HCTZ); Drug: Aliskiren	Phase 4

Study Design

• Study Type: Interventional
• Actual Enrollment: 860 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Double (Participant, Investigator)
• Primary Purpose: Treatment
• Official Title: An 8-week Study to Evaluate the Efficacy and Safety of Aliskiren HCTZ (300/25 mg) Compared to Amlodipine (10 mg) in Patients With Stage 2 Systolic Hypertension and Diabetes Mellitus
• Study Start Date: Nov 1, 2008
• Actual Primary Completion Date: Jan 1, 2010
• Actual Study Completion Date: Jan 1, 2010

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Amlodipine Amlodipine 5 mg for 1 week followed by Amlodipine 10 mg for 7 weeks	Drug: Amlodipine; Amlodipine 5 mg for 1 week followed by Amlodipine 10 mg for 7 weeks
Experimental: Aliskiren / HCTZ Aliskiren / HCTZ 150/12.5 mg for 1 week followed by 300/25 mg for 7 weeks	Drug: Hydrochlorothiazide (HCTZ); Hydrochlorothiazide 12.5 mg for 1 week followed by Hydrochlorothiazide 25 mg for 7 weeks; Drug: Aliskiren; Aliskiren 150 mg for 1 week followed by Aliskiren 300 mg for 7 weeks

Outcome Measures

Primary Outcome Measures

1. Change From Baseline in Mean Sitting Systolic Blood Pressure (msSBP) [Baseline and Week 8]

Secondary Outcome Measures

1. Change From Baseline in Mean Sitting Diastolic Blood Pressure (msDBP) [Baseline and Week 8]

2. Percentage of Responders [Week 8]

   Response defined by mean sitting Systolic Blood Pressure < 130 mm Hg or a reduction of mean sitting Systolic Blood Pressure >= 20 mm Hg from baseline

3. Percentage of Patients Achieving Blood Pressure Control [after 8 weeks of treatment]

   Blood pressure control is defined as patient achieving a target Blood Pressure of mean sitting Systolic BloodPressure / mean sitting Diastolic Blood Pressure < 130/80 mmHg.

4. Biomarker Measurements [Baseline and Week 8]

   Geometric mean of the post to baseline ratio in biomarkers of plasma renin activity (ng/ml/h), plasma renin concentration (ng/L), and cystatin C (mg/L)

5. Evaluate the Safety and Tolerability [after 8 weeks of treatment]

   Percentage of patients with Adverse Event and percentage of patients with edema

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion criteria:

1. Male or female outpatients ≥ 18 years old.

2. Patients with a diagnosis of stage 2 hypertension (defined as an office cuff msSBP ≥ 160 mmHg and < 200 mmHg) at Visit 5 (randomization).

3. Patients with diabetes mellitus (Type 2) with an HbA1c at visit 1 ≤ 9.0 % and currently on stable anti-diabetic regimen or stable diet and exercise for at least 4 weeks prior to visit 1.

4. Patients who are eligible and able to participate in the study, and who are willing to give written informed consent before any assessment is performed.

Exclusion criteria:

1. Office blood pressure measured by cuff (msSBP ≥ 200 mmHg or msDBP ≥ 110 mmHg) at Visits 1-5.

2. History or evidence of secondary hypertension of any etiology (e.g., uncorrected renal artery stenosis, pheochromocytoma).

3. History of hypertensive encephalopathy or heart failure (NYHA Class II-IV).

4. Cerebrovascular accident, transient ischemic cerebral attack (TIA), coronary bypass surgery, myocardial infarction or any percutaneous coronary intervention (PCI) within 1 year prior to Visit 1.

5. Serum sodium less than the lower limit of normal, serum potassium < 3.5 mEq/L (corresponding to 3.5 mmol/L) or ≥ 5.3 mEq/L (corresponding to 5.3 mmol/L), or dehydration at Visit 1.

6. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test (> 5 mIU/mL).

7. Use of other investigational drugs within 30 days of enrollment.

8. History of hypersensitivity to any of the study drugs or to drugs belonging to the same therapeutic class (thiazide diuretics, renin inhibitors, calcium channel blockers, or dihydropyridine like calcium channel blockers) as the study drugs.

9. History of gouty arthritis.

10. Long QT syndrome or QTc > 450 msec for males and > 470 msec for females at screening.

11. History of malignancy of any organ system (other than localized basal cell carcinoma of the skin), treated or untreated, within the past 5 years, regardless of whether there is evidence of local recurrence or metastases.

12. Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant including women whose career, lifestyle, or sexual orientation precludes intercourse with a male partner and women whose partners have been sterilized by vasectomy or other means, UNLESS they are using two birth control methods. The two methods can be a double barrier method or a barrier method plus a hormonal method.

• Adequate barrier methods of contraception include: diaphragm, condom (by the partner), intrauterine device (copper or hormonal), sponge or spermicide. Hormonal contraceptives include any marketed contraceptive agent that includes an estrogen and/or a progestational agent. Reliable contraception should be maintained throughout the study and for 7 days after study drug discontinuation.

• Women are considered post-menopausal and not of child bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or six months of spontaneous amenorrhea with serum FSH levels > 40 mIU/mL (and estradiol< 20 pg/mL) or have had surgical bilateral oophorectomy (with or without hysterectomy) at least six weeks ago. In the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment.

1. Known Keith-Wagener grade III or IV hypertensive retinopathy.

2. Current angina pectoris requiring pharmacological therapy (except sublingual nitroglycerin).

3. Second or third degree heart block without a pacemaker.

4. Atrial fibrillation or atrial flutter at Visit 1, or potentially life-threatening or any symptomatic arrhythmia during the 12 months prior to Visit 1.

5. Clinically significant valvular heart disease.

6. History of angioedema during use of an ACE inhibitor.

7. History or evidence of drug or alcohol abuse within the last 12 months.

8. Any surgical or medical condition, which in the opinion of the investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study.

9. Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of study drugs including, but not limited to, any of the following:

• History of major gastrointestinal tract surgery such as gastrectomy, gastroenterostomy, or bowel resection.

• History of active inflammatory bowel disease during the 12 months prior to Visit

• Currently active gastritis, duodenal or gastric ulcers, or gastrointestinal bleeding during the 3 months prior to Visit 1.

• Any history of pancreatic injury, pancreatitis, or evidence of impaired pancreatic function/injury as indicated by abnormal lipase or amylase during the 12 months prior to Visit 1.

• Evidence of hepatic disease as determined by any one of the following: ALT or AST values exceeding 3 x ULN at Visit 1, a history of hepatic encephalopathy, a history of esophageal varices, or a history of portocaval shunt.

• Evidence of renal impairment as determined by any one of the following: serum creatinine > 1.5 x ULN at Visit 1, a history of dialysis, or a history of nephrotic syndrome.

• Current treatment with cholestyramine or colestipol resins

1. History of noncompliance to medical regimes or unwillingness to comply with the study protocol.

2. Any condition that in the opinion of the investigator would confound the evaluation and interpretation of efficacy and/or safety data.

3. Persons directly involved in the execution of this protocol.

4. Known contraindications to the study drugs.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Sites in USA	East Hanover	New Jersey	United States	07936

Sponsors and Collaborators

• Novartis

Investigators

• Study Chair: Novartis, Novartis

Study Documents (Full-Text)

None provided.

More Information

Additional Information:

• Related Info

Publications

None provided.

• ClinicalTrials.gov Identifier: NCT00787605
• Other Study ID Numbers: CSPP100A2409
• First Posted: Nov 7, 2008
• Last Update Posted: Oct 27, 2016
• Last Verified: May 1, 2011

• Keywords provided by , ,: Hypertension, diabetes mellitus, aliskiren, hydrochlorothiazide, systolic blood pressure, diastolic blood pressure, amlodipine, stage 2
• Additional relevant MeSH terms: Hypertension; Diabetes Mellitus; Systolic Murmurs; Amlodipine; Hydrochlorothiazide

Study Results

Participant Flow

Arm/Group Title	Aliskiren/HCTZ	Amlodipine
Arm/Group Description	Aliskiren / HCTZ 150/12.5 mg for 1 week followed by 300/25 mg for 7 weeks	Amlodipine 5 mg for 1 week followed by 10 mg for 7 weeks
Period Title: Overall Study
STARTED	428	432
COMPLETED	382	376
NOT COMPLETED	46	56

Baseline Characteristics

Arm/Group Title	Aliskiren/HCTZ	Amlodipine	Total
Arm/Group Description	Aliskiren / HCTZ 150/12.5 mg for 1 week followed by 300/25 mg for 7 weeks	Amlodipine 5 mg for 1 week followed by 10 mg for 7 weeks	Total of all reporting groups
Overall Participants	428	432	860
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	59.7 (9.83)	59.8 (10.01)	59.8 (9.91)
Sex: Female, Male (Count of Participants)
Female	212 49.5%	209 48.4%	421 49%
Male	216 50.5%	223 51.6%	439 51%

Outcome Measures

1. Primary Outcome

Title	Change From Baseline in Mean Sitting Systolic Blood Pressure (msSBP)
Time Frame	Baseline and Week 8

Outcome Measure Data

Analysis Population Description

Full analysis set, intent-to-treat

Arm/Group Title	Aliskiren/HCTZ	Amlodipine
Arm/Group Description	Aliskiren / HCTZ 150/12.5 mg for 1 week followed by 300/25 mg for 7 weeks	Amlodipine 5 mg for 1 week followed by 10 mg for 7 weeks
Measure Participants	426	429
Least Squares Mean (Standard Error) [mmHg]	-28.82 (0.722)	-26.22 (0.719)

2. Secondary Outcome

Title	Change From Baseline in Mean Sitting Diastolic Blood Pressure (msDBP)
Time Frame	Baseline and Week 8

Outcome Measure Data

Analysis Population Description

Full analysis set, intent-to-treat

Arm/Group Title	Aliskiren/HCTZ	Amlodipine
Arm/Group Description	Aliskiren / HCTZ 150/12.5 mg for 1 week followed by 300/25 mg for 7 weeks	Amlodipine 5 mg for 1 week followed by 10 mg for 7 weeks
Measure Participants	426	429
Least Squares Mean (Standard Error) [mmHg]	-9.92 (0.414)	-8.97 (0.412)

3. Secondary Outcome

Title	Percentage of Responders
Description	Response defined by mean sitting Systolic Blood Pressure < 130 mm Hg or a reduction of mean sitting Systolic Blood Pressure >= 20 mm Hg from baseline
Time Frame	Week 8

Outcome Measure Data

Analysis Population Description

Full analysis set, intent-to-treat

Arm/Group Title	Aliskiren/HCTZ	Amlodipine
Arm/Group Description	Aliskiren / HCTZ 150/12.5 mg for 1 week followed by 300/25 mg for 7 weeks	Amlodipine 5 mg for 1 week followed by 10 mg for 7 weeks
Measure Participants	426	429
Number [Percentage of Participants]	74.2 17.3%	68.5 15.9%

4. Secondary Outcome

Title	Percentage of Patients Achieving Blood Pressure Control
Description	Blood pressure control is defined as patient achieving a target Blood Pressure of mean sitting Systolic BloodPressure / mean sitting Diastolic Blood Pressure < 130/80 mmHg.
Time Frame	after 8 weeks of treatment

Outcome Measure Data

Analysis Population Description

Full analysis set, intent-to-treat

Arm/Group Title	Aliskiren/HCTZ	Amlodipine
Arm/Group Description	Aliskiren / HCTZ 150/12.5 mg for 1 week followed by 300/25 mg for 7 weeks	Amlodipine 5 mg for 1 week followed by 10 mg for 7 weeks
Measure Participants	426	429
Number [Percentage of Participants]	23.2 5.4%	13.8 3.2%

5. Secondary Outcome

Title	Biomarker Measurements
Description	Geometric mean of the post to baseline ratio in biomarkers of plasma renin activity (ng/ml/h), plasma renin concentration (ng/L), and cystatin C (mg/L)
Time Frame	Baseline and Week 8

Outcome Measure Data

Analysis Population Description

Full analysis set, intent-to-treat

Arm/Group Title	Aliskiren/HCTZ	Amlodipine
Arm/Group Description	Aliskiren / HCTZ 150/12.5 mg for 1 week followed by 300/25 mg for 7 weeks	Amlodipine 5 mg for 1 week followed by 10 mg for 7 weeks
Measure Participants	428	432
Plasma Renin activity (ng/ml/h) (N= 317, 300)	0.42 (2.41)	1.75 (2.10)
Plasma Renin concentration (ng/L) (N=315, 299)	9.53 (189.75)	1.49 (21.59)
Cystatin C (mg/L) (N = 327 , 310)	1.04 (0.15)	0.98 (0.09)

6. Secondary Outcome

Title	Evaluate the Safety and Tolerability
Description	Percentage of patients with Adverse Event and percentage of patients with edema
Time Frame	after 8 weeks of treatment

Outcome Measure Data

Analysis Population Description

safety

Arm/Group Title	Aliskiren/HCTZ	Amlodipine
Arm/Group Description	Aliskiren / HCTZ 150/12.5 mg for 1 week followed by 300/25 mg for 7 weeks	Amlodipine 5 mg for 1 week followed by 10 mg for 7 weeks
Measure Participants	428	431
Any Adverse Event	36.0 8.4%	48.3 11.2%
edema	2.6 0.6%	17.6 4.1%

Adverse Events

Arm/Group Title	Aliskiren/HCTZ		Amlodipine
Arm/Group Description	Aliskiren / HCTZ 150/12.5 mg for 1 week followed by 300/25 mg for 7 weeks		Amlodipine 5 mg for 1 week followed by 10 mg for 7 weeks
All Cause Mortality
	Aliskiren/HCTZ		Amlodipine
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	/ (NaN)		/ (NaN)
Serious Adverse Events
	Aliskiren/HCTZ		Amlodipine
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	3/428 (0.7%)		4/431 (0.9%)
Cardiac disorders
Angina pectoris	0/428 (0%)		1/431 (0.2%)
Angina unstable	1/428 (0.2%)		0/431 (0%)
Coronary artery disease	0/428 (0%)		1/431 (0.2%)
Myocardial ischaemia	0/428 (0%)		1/431 (0.2%)
Gastrointestinal disorders
Rectal haemorrhage	1/428 (0.2%)		0/431 (0%)
General disorders
Non-cardiac chest pain	0/428 (0%)		2/431 (0.5%)
Hepatobiliary disorders
Cholecystitis	1/428 (0.2%)		0/431 (0%)
Musculoskeletal and connective tissue disorders
Pain in extremity	0/428 (0%)		1/431 (0.2%)
Vascular disorders
Hypertension	0/428 (0%)		1/431 (0.2%)
Other (Not Including Serious) Adverse Events
	Aliskiren/HCTZ		Amlodipine
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	28/428 (6.5%)		86/431 (20%)
General disorders
Oedema peripheral	9/428 (2.1%)		70/431 (16.2%)
Nervous system disorders
Headache	19/428 (4.4%)		22/431 (5.1%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

The terms and conditions of Novartis' agreements with its investigators may vary. However, Novartis does not prohibit any investigator from publishing. Any publications from a single-site are postponed until the publication of the pooled data (i.e., data from all sites) in the clinical trial; or the publication of the trial results in their entirety.