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Stratification of Blood Pressure Control Against Progress of Cerebral Small Vessel Diseases in Poststroke Patients (APPROVE)

Primary Purpose

Cerebral Small Vessel Diseases

Status
Unknown status
Phase
Phase 4
Locations
China
Study Type
Interventional
Intervention
Azelnidipine
Perindopril
hydrochlorothiazide
Sponsored by
Yining Huang
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cerebral Small Vessel Diseases focused on measuring cerebral small Vessel diseases, blood pressure,CCB, ACEI

Eligibility Criteria

40 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Cerebral infarction within 10 days to 6 months.
  • Clinical manifestation represented as lacunar infarction syndrome; without aphasia or disturbance of consciousness.
  • Mini-Mental State Examination(MMSE)>24 and modified Rankin Score(mRS)≤3.
  • History of hypertension, and need to be treated with drugs; patient who had been diagnosis hypertension or the first time with the diagnosis of this disease after the guideline of China 2010 (measurement of the BP in the seated posture of the up arm after having a rest for 5 minutes and was taken for three times and calculated the average result, make sure the difference of BP between right and left arm are not beyond the criteria of 20 mmHg and the right arm for consistence. The patients have different BP between both sides which the difference beyond 20 mmHg need to exam for the stenosis of subclavian artery.
  • MRI confirm the lesion for lacunar infarction and be responsible for the clinical symptom located in the region of perforating artery and the diameter of the lesion is less than 20mm.
  • The examinations of carotid artery and intracranial artery have excluded hemodynamic abnormalities due to artery stenosis ( stenosis >50%, the examination of intracranial artery was by the methods of TCD/ MRA/ CTA/ DSA, the examination of carotid artery was by the methods of colorful ultrasound / MRA/ CTA/ DSA ). The combination of thickness Intima media or plaque of the carotid artery without the hemodynamic dysfunction can be enrolled in this research.
  • Informed consent was signed.

Exclusion Criteria:

  • Hypertension diffcult to control, instantly over 220/ 120 mmHg.
  • History of atrial fibrillation (Paroxysmal or sustained).
  • History of heart infarction within 6 months.
  • Stenosis above 50% or hemodynamic dysfunction in carotid and intracranial artery after examination.
  • Unknown caused of brain infarction, like dissection vascular, Moyamoya disease, vasculitis, hereditary small angiopathy ( eg,Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy(CADASIL), FABRY, mitochondrial encephalopathy).
  • Severe liver and renal disease. the definition of sever liver disease was Alanine aminotransferase(ALT) or Aspartate aminotransferase(AST) 4 times than the normal level, or the total bilirubin above 20 mmol/L, or cirrhosis. the definition of sever renal disease was stenosis of renal artery and dysfunction of renal (clearance rate of creatinine <60ml/min or serum creatinine >265mmol/L).
  • History of hemorrhage.
  • Active bleeding disease or clear coagulation disorders.
  • Malignant neoplasm.
  • Pregnancy.
  • Severe organic diseases, expected lifetime was shorter than 2 years.
  • Conditions contraindicated for CCB or ACEI, such as hyperpotassaemia (serum potassium >5.5mmol/L) or have the evidence proved allergic to both drugs.
  • Eenrolled in another clinical trial in 30 days.

Sites / Locations

  • Peking University First HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Sham Comparator

Experimental

Arm Label

Normal Azelnidipine/Perindopril

Intensive Azelnidipine/Perindopril

Arm Description

Systole blood pressure controlled between 130 mmHg~140 mmHg(with or without hydrochlorothiazide).

Systole blood pressure controlled below 130 mmHg(with or without hydrochlorothiazide).

Outcomes

Primary Outcome Measures

Cerebral Small Vessel Disease progressing
Area of WML increase more than 4% or Number of CMBs increase more than 2

Secondary Outcome Measures

Full Information

First Posted
March 24, 2013
Last Updated
October 22, 2015
Sponsor
Yining Huang
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1. Study Identification

Unique Protocol Identification Number
NCT01819441
Brief Title
Stratification of Blood Pressure Control Against Progress of Cerebral Small Vessel Diseases in Poststroke Patients
Acronym
APPROVE
Official Title
Azelnidipine vs Perindopril and Stratification of Blood Pressure Control Against Progress of Cerebral Small Vessel Diseases in Poststroke Patients (APPROVE):Multi-center Randomized Controlled Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
October 2015
Overall Recruitment Status
Unknown status
Study Start Date
May 2012 (undefined)
Primary Completion Date
December 2016 (Anticipated)
Study Completion Date
December 2016 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Yining Huang

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
A. the controlling of the blood pressure, especially the variation of blood pressure, can slow down the development of the small vessel disease. B intensive BP control is more effective than normal control of blood pressure in slowing down the small vessel disease. C drugs of Calcium Channel Blocker(CCB) and Angiotensin-Converting Enzyme Inhibitor(ACEI) have no significant difference in lowing the blood pressure and variability of blood pressure
Detailed Description
The selected patients were diagnosis of stroke caused by small vessel disease due to hypertension recently. The patients had been divided into two groups by random principle and given ACEI or CCB separately for treatment. At the same time, given intensive or regular controlling of the blood pressure by stratified random. In the regular controlling group, the BP should be in the range of 130-139 mmHg and in the intensive controlling group, the BP should be below 130 mmHg. To the acute ischemic stroke patients who were accord with the lacunar infarction syndrome, it is rule to do the examination for exclusive selection of exclusion of hemodynamic dysfunction due to the artery stenosis ( stenosis >50%, the examination of intracranial artery was by the methods of Transcranial Doppler (TCD)/Magnetic Resonance Angiography(MRA)/Computed Tomographic Angiography(CTA)/Digital Subtraction Angiography(DSA), the examination of carotid artery was by the methods of colorful ultrasound / MRA/ CTA/ DSA ) at the baseline. It should be proved of lacunar infarction by brain imaging. All patients had a MRI scan at the baseline and the beginning of the research, including T1-Weighted Imaging(T1W1),T2-Weighted Imaging(T2WI), T2-FLAIR, Diffusion-Weighted Imaging(DWI), Gradient-Recalled Echo(GRE) T2*, the Perfusion-Weighted Imaging(PWI) would complete conditionally (100 cases). The details should be followed by the instruction in the appendix. Research about the variability of blood pressure: all patients show complete the examination of 24-hour blood-pressure monitor (at the baseline, the first month after the beginning, every three months and the end of the research), complete the head-up tilt test if conditionally ( at the baseline, each 3 months later and the end of the research ) The automatic regulation function of the small vessel should be evaluated if conditionally (the C02 reaction, TCD head-up tilt) and also the function of endothelium-derived relaxing of the brachial artery (at the baseline, each 3 months later and the end of the research) The reservation of the blood was for further research on genetic study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cerebral Small Vessel Diseases
Keywords
cerebral small Vessel diseases, blood pressure,CCB, ACEI

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
1200 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Normal Azelnidipine/Perindopril
Arm Type
Sham Comparator
Arm Description
Systole blood pressure controlled between 130 mmHg~140 mmHg(with or without hydrochlorothiazide).
Arm Title
Intensive Azelnidipine/Perindopril
Arm Type
Experimental
Arm Description
Systole blood pressure controlled below 130 mmHg(with or without hydrochlorothiazide).
Intervention Type
Drug
Intervention Name(s)
Azelnidipine
Other Intervention Name(s)
BeiQi
Intervention Description
8mg or 16mg
Intervention Type
Drug
Intervention Name(s)
Perindopril
Other Intervention Name(s)
YiTai
Intervention Description
4mg or 8mg
Intervention Type
Drug
Intervention Name(s)
hydrochlorothiazide
Intervention Description
12.5mg or 25mg
Primary Outcome Measure Information:
Title
Cerebral Small Vessel Disease progressing
Description
Area of WML increase more than 4% or Number of CMBs increase more than 2
Time Frame
two years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Cerebral infarction within 10 days to 6 months. Clinical manifestation represented as lacunar infarction syndrome; without aphasia or disturbance of consciousness. Mini-Mental State Examination(MMSE)>24 and modified Rankin Score(mRS)≤3. History of hypertension, and need to be treated with drugs; patient who had been diagnosis hypertension or the first time with the diagnosis of this disease after the guideline of China 2010 (measurement of the BP in the seated posture of the up arm after having a rest for 5 minutes and was taken for three times and calculated the average result, make sure the difference of BP between right and left arm are not beyond the criteria of 20 mmHg and the right arm for consistence. The patients have different BP between both sides which the difference beyond 20 mmHg need to exam for the stenosis of subclavian artery. MRI confirm the lesion for lacunar infarction and be responsible for the clinical symptom located in the region of perforating artery and the diameter of the lesion is less than 20mm. The examinations of carotid artery and intracranial artery have excluded hemodynamic abnormalities due to artery stenosis ( stenosis >50%, the examination of intracranial artery was by the methods of TCD/ MRA/ CTA/ DSA, the examination of carotid artery was by the methods of colorful ultrasound / MRA/ CTA/ DSA ). The combination of thickness Intima media or plaque of the carotid artery without the hemodynamic dysfunction can be enrolled in this research. Informed consent was signed. Exclusion Criteria: Hypertension diffcult to control, instantly over 220/ 120 mmHg. History of atrial fibrillation (Paroxysmal or sustained). History of heart infarction within 6 months. Stenosis above 50% or hemodynamic dysfunction in carotid and intracranial artery after examination. Unknown caused of brain infarction, like dissection vascular, Moyamoya disease, vasculitis, hereditary small angiopathy ( eg,Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy(CADASIL), FABRY, mitochondrial encephalopathy). Severe liver and renal disease. the definition of sever liver disease was Alanine aminotransferase(ALT) or Aspartate aminotransferase(AST) 4 times than the normal level, or the total bilirubin above 20 mmol/L, or cirrhosis. the definition of sever renal disease was stenosis of renal artery and dysfunction of renal (clearance rate of creatinine <60ml/min or serum creatinine >265mmol/L). History of hemorrhage. Active bleeding disease or clear coagulation disorders. Malignant neoplasm. Pregnancy. Severe organic diseases, expected lifetime was shorter than 2 years. Conditions contraindicated for CCB or ACEI, such as hyperpotassaemia (serum potassium >5.5mmol/L) or have the evidence proved allergic to both drugs. Eenrolled in another clinical trial in 30 days.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Peking University First Hospital
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yining Huang, M.D.
Organizational Affiliation
Peking University First Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Peking University First Hospital
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100034
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Yining Huang
Email
ynhuang@sina.com

12. IPD Sharing Statement

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Stratification of Blood Pressure Control Against Progress of Cerebral Small Vessel Diseases in Poststroke Patients

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