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A Randomized Clinical Trial To Study Losartan On Endothelial Dysfunction and Insulin Resistance In Obese Patients

Primary Purpose

Obesity, Hypertension, Hyperglycemia

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
losartan
Placebo control
Sponsored by
Brigham and Women's Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Obesity focused on measuring Impaired Fasting Glucose FPG >100-<126 mg/dL

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Currently taking 1 or no antihypertensive medication
  • Male and female between 18 and 75 years of age
  • Mean trough sitting diastolic blood pressure (SiDBP) ≥80 and < 100 mm Hg
  • Mean trough sitting systolic blood pressure (SiSBP) ≥120 and <160 mm Hg
  • Non-diabetic patients with fasting plasma glucose ≥100 mg/dL and <126 mg/dL
  • Body mass index (BMI) >30 and <40
  • Waist circumference >40 inches in males, > 35 inches in females
  • A patient who is of reproductive potential and agrees to remain abstinent or use acceptable methods of birth control (intrauterine device (IUD), diaphragm with spermicide, contraceptive sponge, condom, hormonal contraception, vasectomy) within the projected duration of the study

Exclusion Criteria:

  • Secondary hypertension of any etiology (renal artery stenosis, coarctation of the aorta or pheochromocytoma, hypertension induced by oral contraceptives)
  • History of malignant hypertension
  • Any clinically significant renal disease including single functioning kidney, and known history of anuria. Any severe renal impairment, as manifested by serum creatinine more than 1.5 mg/dL, or proteinuria >2+ by urine dipstick
  • Known sensitivity or intolerance to angiotensin II receptor antagonists
  • Type I or II diabetes
  • Inability or unwillingness to abstain from taking prohibited medications during the study period
  • History of myocardial infarction (MI), percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), congestive heart failure (CHF), unstable angina, transient ischemic attack (TIA), or cerebrovascular accident (CVA)
  • Concomitant cardiac conditions that would make it unsafe to participate in the trial (e.g., clinically significant atrioventricular (AV) conduction disturbance, atrial flutter, atrial fibrillation, potentially life-threatening ventricular arrhythmias, decompensated valvular disease, presence of hemodynamically significant obstructive valvular disease, or cardiomyopathy)
  • History of angioedema and/or organ damage from hypertension
  • Serum potassium < 3.5 or > 5.5 mEq/L
  • Any clinically significant laboratory value which in the investigator's judgment could be clinically significant to the outcome of this study.
  • History of clinically important gastrointestinal resection or malabsorption
  • Patient with a history or current evident of any condition, therapy, lab abnormality, or other circumstance that might confound the results of the study, or interfere with the patient's participation for the full duration of the study, such that it is not in the best interest of the patient to participate. (Including but not limited to: recent or current alcoholism, drug abuse within the prior 2 years, mental or legal incapacitation, any disease which could reasonably be expected to be fatal or life-threatening, or a history of malignancy ≤ 5 years prior to signing informed consent.)
  • Currently participating or has participated in a study with an investigational compound or device within 30 days of signing informed consent.
  • Inability to be taken off all current antihypertensive medication and placed on placebo for up to 12 weeks.
  • Unwillingness or unlikely to adhere to the study procedures, keep appointments, or is planning to relocate during the study.
  • Arm circumference great than 52 cm
  • Smokers or former smokers who have quite less than 1 year prior to Visit 1
  • Anemia (Hemoglobin < 11)
  • Allergy to latex
  • Deformed hands and/or fingers that would interfere with the collection of pulse volume amplitude measurements
  • History of Raynaud's disease or any other vascular condition
  • Bilateral mastectomy
  • Aortic stenosis
  • Patient is taking high doses of antioxidant supplements (vitamins, minerals, or other)

Sites / Locations

  • CAVS Clinical Research Center
  • VA San Diego Health Care System
  • University of Miami Diabetes Research Institute
  • Indiana University School of Medicine
  • Brigham and Women's Hospital Cardiovascular Division
  • St. Lukes Roosevelt Hospital
  • University of Pennsylvania School of Medicine
  • University of Texas SW Medical Center at Dallas
  • Hypertension Clinical Pharmacology Baylor Clinic

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Losartan

Placebo

Arm Description

Losartan 100 mg 1 tab po QD

Placebo 1 tab po QD

Outcomes

Primary Outcome Measures

Insulin Sensitivity Utilizing the Euglycemic Hyperinsulinemic Clamp
Insulin clamp derived insulin sensitivity, as insulin stimulated glucose disposal corrected for steady state insulin level.
Insulin Sensitivity Utilizing Endothelial Function as Assessed by Pulse Volume Amplitude
Endothelial function assessed as the ratio of pulse volume amplitude after compared with before a reactive hyperemia stimulus, measured by peripheral (fingertip) arterial tonometry. Reported values indicate the percentage change from Baseline in the ratio of pulse volume amplitude after compared to before the reactive hyperemia stimulus.

Secondary Outcome Measures

Change in Urine Albumin/Creatine
Urine was obtained to assess for the presence of microalbuminuria.
Change in hsCRP (High-sensitivity C-reactive Protein)
hsCRP (high-sensitivity C-reactive protein) is a marker of inflammation
Change in VCAM-1(Vascular Cell-adhesion Molecule-1)
VCAM-1 is an immunoglobulin-like adhesion molecule expressed on activated endothelial cells.
Change in MCP-1 (Monocyte Chemoattractant Protein-1)
MCP-1 is one of the key chemokines that regulate migration and infiltration of monocytes/macrophages.
Change in Ox-LDL (Oxidized Low-density Lipoprotein)
ox-LDL measures protein damage due to the oxidative modification of the ApoB subunit on LDL cholesterol.
Change in F2-isoprostanes
F2-isoprostanes is a marker of oxidative stress.
Change in E-selectin
E-selectin is expressed on inflamed endothelial cells in response to treatment with inflammatory cytokines.

Full Information

First Posted
May 8, 2008
Last Updated
August 9, 2018
Sponsor
Brigham and Women's Hospital
Collaborators
Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT00675987
Brief Title
A Randomized Clinical Trial To Study Losartan On Endothelial Dysfunction and Insulin Resistance In Obese Patients
Official Title
Protocol Merck 318-00: A Double-Blind, Placebo-Controlled, Randomized, Parallel, Clinical Trial To Study The Effect Of Losartan Potassium On Endothelial Dysfunction And Insulin Resistance In Obese Patients With Impaired Fasting Glucose
Study Type
Interventional

2. Study Status

Record Verification Date
August 2018
Overall Recruitment Status
Completed
Study Start Date
May 2007 (undefined)
Primary Completion Date
December 2008 (Actual)
Study Completion Date
December 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Brigham and Women's Hospital
Collaborators
Merck Sharp & Dohme LLC

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The main purposes of this study are to find out if the study drug losartan (Cozaar) or placebo ("sugar pill") has an effect on insulin sensitivity (how your body responds to insulin) and to measure the effect of the study drug losartan or placebo on how the arteries in your arm dilate (enlarge to carry more blood). We hope to learn if taking losartan changes the amount of certain proteins in the blood that effect blood vessel function. Losartan is approved by the US FDA to treat high blood pressure. It will take approximately 4 months for you to complete this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obesity, Hypertension, Hyperglycemia
Keywords
Impaired Fasting Glucose FPG >100-<126 mg/dL

7. Study Design

Primary Purpose
Other
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
53 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Losartan
Arm Type
Active Comparator
Arm Description
Losartan 100 mg 1 tab po QD
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo 1 tab po QD
Intervention Type
Drug
Intervention Name(s)
losartan
Other Intervention Name(s)
Cozaar
Intervention Description
losartan 100 mg tablets 1 tab po QD
Intervention Type
Drug
Intervention Name(s)
Placebo control
Intervention Description
Placebo 1 po QD
Primary Outcome Measure Information:
Title
Insulin Sensitivity Utilizing the Euglycemic Hyperinsulinemic Clamp
Description
Insulin clamp derived insulin sensitivity, as insulin stimulated glucose disposal corrected for steady state insulin level.
Time Frame
baseline, 8 weeks
Title
Insulin Sensitivity Utilizing Endothelial Function as Assessed by Pulse Volume Amplitude
Description
Endothelial function assessed as the ratio of pulse volume amplitude after compared with before a reactive hyperemia stimulus, measured by peripheral (fingertip) arterial tonometry. Reported values indicate the percentage change from Baseline in the ratio of pulse volume amplitude after compared to before the reactive hyperemia stimulus.
Time Frame
baseline, 8 weeks
Secondary Outcome Measure Information:
Title
Change in Urine Albumin/Creatine
Description
Urine was obtained to assess for the presence of microalbuminuria.
Time Frame
baseline, 8 weeks
Title
Change in hsCRP (High-sensitivity C-reactive Protein)
Description
hsCRP (high-sensitivity C-reactive protein) is a marker of inflammation
Time Frame
baseline, 8 weeks
Title
Change in VCAM-1(Vascular Cell-adhesion Molecule-1)
Description
VCAM-1 is an immunoglobulin-like adhesion molecule expressed on activated endothelial cells.
Time Frame
baseline, 8 weeks
Title
Change in MCP-1 (Monocyte Chemoattractant Protein-1)
Description
MCP-1 is one of the key chemokines that regulate migration and infiltration of monocytes/macrophages.
Time Frame
baseline, 8 weeks
Title
Change in Ox-LDL (Oxidized Low-density Lipoprotein)
Description
ox-LDL measures protein damage due to the oxidative modification of the ApoB subunit on LDL cholesterol.
Time Frame
baseline, 8 weeks
Title
Change in F2-isoprostanes
Description
F2-isoprostanes is a marker of oxidative stress.
Time Frame
baseline, 8 weeks
Title
Change in E-selectin
Description
E-selectin is expressed on inflamed endothelial cells in response to treatment with inflammatory cytokines.
Time Frame
baseline, 8 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Currently taking 1 or no antihypertensive medication Male and female between 18 and 75 years of age Mean trough sitting diastolic blood pressure (SiDBP) ≥80 and < 100 mm Hg Mean trough sitting systolic blood pressure (SiSBP) ≥120 and <160 mm Hg Non-diabetic patients with fasting plasma glucose ≥100 mg/dL and <126 mg/dL Body mass index (BMI) >30 and <40 Waist circumference >40 inches in males, > 35 inches in females A patient who is of reproductive potential and agrees to remain abstinent or use acceptable methods of birth control (intrauterine device (IUD), diaphragm with spermicide, contraceptive sponge, condom, hormonal contraception, vasectomy) within the projected duration of the study Exclusion Criteria: Secondary hypertension of any etiology (renal artery stenosis, coarctation of the aorta or pheochromocytoma, hypertension induced by oral contraceptives) History of malignant hypertension Any clinically significant renal disease including single functioning kidney, and known history of anuria. Any severe renal impairment, as manifested by serum creatinine more than 1.5 mg/dL, or proteinuria >2+ by urine dipstick Known sensitivity or intolerance to angiotensin II receptor antagonists Type I or II diabetes Inability or unwillingness to abstain from taking prohibited medications during the study period History of myocardial infarction (MI), percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), congestive heart failure (CHF), unstable angina, transient ischemic attack (TIA), or cerebrovascular accident (CVA) Concomitant cardiac conditions that would make it unsafe to participate in the trial (e.g., clinically significant atrioventricular (AV) conduction disturbance, atrial flutter, atrial fibrillation, potentially life-threatening ventricular arrhythmias, decompensated valvular disease, presence of hemodynamically significant obstructive valvular disease, or cardiomyopathy) History of angioedema and/or organ damage from hypertension Serum potassium < 3.5 or > 5.5 mEq/L Any clinically significant laboratory value which in the investigator's judgment could be clinically significant to the outcome of this study. History of clinically important gastrointestinal resection or malabsorption Patient with a history or current evident of any condition, therapy, lab abnormality, or other circumstance that might confound the results of the study, or interfere with the patient's participation for the full duration of the study, such that it is not in the best interest of the patient to participate. (Including but not limited to: recent or current alcoholism, drug abuse within the prior 2 years, mental or legal incapacitation, any disease which could reasonably be expected to be fatal or life-threatening, or a history of malignancy ≤ 5 years prior to signing informed consent.) Currently participating or has participated in a study with an investigational compound or device within 30 days of signing informed consent. Inability to be taken off all current antihypertensive medication and placed on placebo for up to 12 weeks. Unwillingness or unlikely to adhere to the study procedures, keep appointments, or is planning to relocate during the study. Arm circumference great than 52 cm Smokers or former smokers who have quite less than 1 year prior to Visit 1 Anemia (Hemoglobin < 11) Allergy to latex Deformed hands and/or fingers that would interfere with the collection of pulse volume amplitude measurements History of Raynaud's disease or any other vascular condition Bilateral mastectomy Aortic stenosis Patient is taking high doses of antioxidant supplements (vitamins, minerals, or other)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mark A Creager, MD
Organizational Affiliation
Brigham and Women's Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
CAVS Clinical Research Center
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72205
Country
United States
Facility Name
VA San Diego Health Care System
City
San Diego
State/Province
California
ZIP/Postal Code
92161
Country
United States
Facility Name
University of Miami Diabetes Research Institute
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Indiana University School of Medicine
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Facility Name
Brigham and Women's Hospital Cardiovascular Division
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
St. Lukes Roosevelt Hospital
City
New York
State/Province
New York
ZIP/Postal Code
10025
Country
United States
Facility Name
University of Pennsylvania School of Medicine
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
University of Texas SW Medical Center at Dallas
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390
Country
United States
Facility Name
Hypertension Clinical Pharmacology Baylor Clinic
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
21861845
Citation
Perlstein TS, Henry RR, Mather KJ, Rickels MR, Abate NI, Grundy SM, Mai Y, Albu JB, Marks JB, Pool JL, Creager MA. Effect of angiotensin receptor blockade on insulin sensitivity and endothelial function in abdominally obese hypertensive patients with impaired fasting glucose. Clin Sci (Lond). 2012 Feb;122(4):193-202. doi: 10.1042/CS20110284.
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A Randomized Clinical Trial To Study Losartan On Endothelial Dysfunction and Insulin Resistance In Obese Patients

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