Randomized, Open Labeled Clinical Trial to Compare the Effectiveness of Amlodipine/Valsartan vs Hydrochlorothiazide/Telmisartan on Glucose Tolerance in Patients With Hypertension With Metabolic Syndrome
Study Details
Study Description
Brief Summary
Recent studies have demonstrated that RAS inhibitors/calcium channel blockers are superior to RAS inhibitors/diuretics for reducing cardiovascular outcomes in hypertension. As such, RAS inhibitors/calcium channel blockers are recommended as first line combination treatment for hypertension. However, the mechanism for the superior efficacy of RAS inhibitors/calcium channel blockers are not well defined. This study will compare the efficacy of RAS inhibitors/calcium channel blockers vs RAS inhibitors/diuretics in terms of glucose tolerance and insulin resistance in hypertensive patients with metabolic syndrome. The primary endpoint will be that RAS inhibitors/calcium channel blockers will be more efficacious in reducing 2hour post prandial glucose compared to RAS inhibitors/diuretics.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 4 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Active Comparator: amlodipine/valsartan
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Drug: amlodipine/valsartan
This is a phase IV clinical study. The study is a 24 week, prospective, randomized open labeled multicenter study to compare the efficacy of amlodipine/valsartan combination vs telmisartan/hydrochlorothiazide combination in reducing post prandial sugar. The study will be performed in hypertensive patients with metabolic syndrome.
Active group: Starting dose of amlodipine 5mg/ valsartan 80mg comparator group: Telmisartan 40mg/hydrochlorothiazide 12.5mg When the blood pressure is above the target goal of 140/90mmHg, up titration to amlodipine 5/valsartan 160 and/or telmisartan 80/hydrochlorothiazide 12.5mg is allowed.
When the blood pressure is above 140/90mmhg at the 12th week, addition of doxazosin 4mg is allowed.
Other Names:
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Experimental: hydrochlorothiazide/telmisartan
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Drug: hydrochlorothiazide/telmisartan
When the blood pressure is above the target goal of 140/90mmHg, uptitration to amlodipine 5/valsartan 160 and/or telmisartan 80/hydrochlorothiazide 12.5mg is allowed.
When the blood pressure is above 140/90mmhg at the 12th week, addition of doxazosin 4mg is allowed.
Other Names:
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Outcome Measures
Primary Outcome Measures
- To assess the glucose change [To assess the change from baseline (week 0) to study endpoint (week 24) on 2hr-post-prandial plasma glucose level using oral glucose tolerance test (75-g OGTT)]
Eligibility Criteria
Criteria
Inclusion Criteria:
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consent to the study
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Male or Female ≥ 20 years
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Patients taking less than 1 antihypertensive medications or not taking antihypertensive medications. Hypertension defined at the screening visit as follows): 140mmHg < MSSBP or MSDBP > 90mmHg at screening
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Hypertensive patients with non diabetic metabolic syndrome will be enrolled. Metabolic syndrome is defined according to NCEP guideline. (3 or more than) ① Abdominal obesity: Waist circumference M ≥ 90cm, F ≥ 80cm
② Hypertriglyceridaemia: Triglycerides ≥ 150mg/dL
③ Low HDL cholesterol Men: HDL cholesterol ≤ 40mg/dL Women: HDL cholesterol ≤ 50mg/dL
④ Elevated blood pressure (systolic blood pressure ≥ 130 mmHg and diastolic blood pressure ≥ 85 mmHg, or current use of antihypertensive drugs)
⑤ Impaired fasting glucose: fasting plasma glucose ≥ 100 mg/dL
- Patient not taking statin medication and if the patient had ate statin medication the last duration must be before 3 months.
Exclusion Criteria:
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• Women of child-bearing potential without a contraceptive measure
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(Pregnant or nursing women
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Known or suspected contraindications: history of allergy or hypersensitivity
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History of clinically significant allergies including asthma and/or multiple drug allergies
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Patients taking more than 2 antihypertensive medications
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Patient taking statin medication and taking statin within 3 months
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MSSBP > 180 mmHg or MSDBP > 110 mmHg at any time during the study
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Evidence of a secondary form of hypertension)
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History of hypertensive encephalopathy, cerebrovascular accident, transient ischemic attack, myocardial infarction, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) for 12 months prior to Visit 1
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History of heart failure Grade II - IV according to the NYHA classification
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Concomitant potentially life threatening arrhythmia or symptomatic arrhythmia
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Concomitant unstable angina pectoris
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Clinically significant valvular heart disease
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Patients with Type 1 or Type 2 diabetes mellitus
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Evidence of hepatic disease as determined by one of the following: AST or ALT values ≥ 3 x UNL, a history of hepatic encephalopathy, history of esophageal varices, or history of portocaval shunt
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Evidence of renal impairment as determined by one of the following: serum creatinine >2mg/dL , history of dialysis, or history of nephrotic syndrome
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Protein in U/A values 2+ ≤
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Serum potassium values < 3.2 or > 5.2 mmol/L
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History of malignancy of any organ system within the past 5 years, treated or untreated, including leukemia and lymphoma, as further defined in the full protocol
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Chronic use of NSAIDs
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Use of cyclooxygenase-2 inhibitors (COX-2 inhibitors
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Use of niacin > 100 mg/d
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Use of loop diuretics
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Use of statin shorter than 3 months
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Inability to discontinue prior antihypertensive drugs as specified in the full protocol
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persons directly involved in the execution of this protocol
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Volume depletion based on the investigator's clinical judgment using vital signs, skin turgor, moistness of mucous membranes, and laboratory values
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Any severe, life-threatening disease within the past five years
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Yonsei universty medical center | Seoul | Korea, Republic of | 120-752 |
Sponsors and Collaborators
- Yonsei University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 4-2009-0077