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Etiology of Sleep Apnea-related Hyperaldosteronism - BP Treatment

Primary Purpose

Obstructive Sleep Apnea, Resistant Hypertension, Hyperaldosteronism

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Spironolactone
BP medication uptitration
Sponsored by
University of Alabama at Birmingham
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Obstructive Sleep Apnea focused on measuring sleep apnea, hypertension, aldosterone, hyperaldosteronism, spironolactone, blood pressure, resistant

Eligibility Criteria

19 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Resistant hypertension defined as office BP that is uncontrolled with 3 or more antihypertensive medications
  • Moderate-severe OSA defined as AHI ≥15 events/hr
  • Self-reported adherence >80% with prescribed antihypertensive medications.

Exclusion Criteria:

  • Ongoing use of a potassium sparing diuretic
  • History of congestive heart failure (ejection fraction of <40%)
  • Chronic kidney disease (creatinine clearance <60 ml/min)
  • History of cardiovascular disease (stroke, TIA, myocardial infarction, or revascularization procedure)
  • Known or suspected history of secondary cause of hypertension other than primary aldosteronism
  • Severe nocturnal hypoxemia (O2 desaturation nadir <60%)
  • White coat hypertension defined as office BP >140/90 mm Hg and ambulatory daytime BP <135/85 mm Hg
  • Central sleep apnea (defined as 5% or more of the apneas as central apneas) and/or the presence of any Cheyne-Stokes breathing
  • Subjects working shift work or having other known circadian rhythm disorders such that their sleep-wake schedule is altered
  • Excessive daytime sleepiness as indicated by an Epworth score of >10
  • Pregnant Women

Sites / Locations

  • University of Alabama at Birmingham

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Sham Comparator

Arm Label

Spironolactone

Standard of care BP treatment

Arm Description

Spironolactone 25 mg administered following baseline measurements and uptitrated to 50 mg if BP > 140/90 mm Hg throughout the 3 month study.

Antihypertensive medication added and/or uptitrated to keep BP < 140/90 mm Hg throughout the study.

Outcomes

Primary Outcome Measures

Severity of Obstructive Sleep Apnea
3 month change in apnea-hypopnea index assessed by diagnostic, full-night polysomnography. AHI values are typically categorized as 5-15/hr = mild; 15-30/hr = moderate; and > 30/h = severe.

Secondary Outcome Measures

Full Information

First Posted
July 9, 2013
Last Updated
December 13, 2013
Sponsor
University of Alabama at Birmingham
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)
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1. Study Identification

Unique Protocol Identification Number
NCT01897727
Brief Title
Etiology of Sleep Apnea-related Hyperaldosteronism - BP Treatment
Official Title
Randomized Controlled Trial of Spironolactone Versus Standard of Care Blood Pressure Treatment on the Severity of Obstructive Sleep Apnea in Patients With Resistant Hypertension
Study Type
Interventional

2. Study Status

Record Verification Date
December 2013
Overall Recruitment Status
Completed
Study Start Date
January 2009 (undefined)
Primary Completion Date
April 2012 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Alabama at Birmingham
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Hypertension affects an estimated 60-70 million Americans, predisposing them to potentially life threatening cardiovascular complications. Resistant hypertension, defined as uncontrolled blood pressure on 3 or more different antihypertensive agents, is common, affecting 15-20% of the entire hypertensive population or an estimated 12-14 million Americans. Although associated with obesity, increasing age, black race, and chronic kidney disease, mechanisms of treatment resistance remain obscure. The investigators' laboratory identified primary aldosteronism (PA) as a common cause of treatment resistance with a prevalence of 20% among subjects with resistant hypertension. This is clinically important because recognition of PA can lead to effective treatment with use of aldosterone blockers. Obstructive sleep apnea (OSA) is strongly associated with and predicts development of hypertension as demonstrated in landmark cohort studies including the Sleep Heart Health Study and the Wisconsin Sleep Cohort Study. The investigators' laboratory has confirmed OSA to be extremely common in subjects with resistant hypertension, with a prevalence of approximately 85%. Recognizing that PA and OSA are exceptionally common in subjects with resistant hypertension, the investigators hypothesized that the 2 may be causally related. In testing this hypothesis, the investigators recently reported that plasma aldosterone levels are positively correlated with OSA severity in subjects with resistant hypertension but not in normotensive control subjects. This observation suggests that there is an important mechanistic interaction between untreated OSA and aldosterone excess in subjects with resistant hypertension. While the investigators' original hypothesis was that OSA stimulates aldosterone release, the investigators recognize that the opposite may also be true; that is, aldosterone excess in subjects with resistant hypertension worsens OSA. Distinguishing between these two possibilities has potentially far-reaching clinical implications. If the former hypothesis is true, effective treatment of OSA would be expected to suppress aldosterone release in subjects with resistant hypertension, thereby reversing the underlying cause of their treatment resistance. If the latter hypothesis is true, use of mineralocorticoid receptor antagonists would be expected to reduce OSA severity in subjects with resistant hypertension, thereby enhancing treatment of OSA. Either scenario would represent a new treatment approach for a highly prevalent and serious medical problem.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obstructive Sleep Apnea, Resistant Hypertension, Hyperaldosteronism
Keywords
sleep apnea, hypertension, aldosterone, hyperaldosteronism, spironolactone, blood pressure, resistant

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
41 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Spironolactone
Arm Type
Active Comparator
Arm Description
Spironolactone 25 mg administered following baseline measurements and uptitrated to 50 mg if BP > 140/90 mm Hg throughout the 3 month study.
Arm Title
Standard of care BP treatment
Arm Type
Sham Comparator
Arm Description
Antihypertensive medication added and/or uptitrated to keep BP < 140/90 mm Hg throughout the study.
Intervention Type
Drug
Intervention Name(s)
Spironolactone
Intervention Type
Drug
Intervention Name(s)
BP medication uptitration
Intervention Description
antihypertensive medication added or uptitrated following standard of care
Primary Outcome Measure Information:
Title
Severity of Obstructive Sleep Apnea
Description
3 month change in apnea-hypopnea index assessed by diagnostic, full-night polysomnography. AHI values are typically categorized as 5-15/hr = mild; 15-30/hr = moderate; and > 30/h = severe.
Time Frame
baseline and 3 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Resistant hypertension defined as office BP that is uncontrolled with 3 or more antihypertensive medications Moderate-severe OSA defined as AHI ≥15 events/hr Self-reported adherence >80% with prescribed antihypertensive medications. Exclusion Criteria: Ongoing use of a potassium sparing diuretic History of congestive heart failure (ejection fraction of <40%) Chronic kidney disease (creatinine clearance <60 ml/min) History of cardiovascular disease (stroke, TIA, myocardial infarction, or revascularization procedure) Known or suspected history of secondary cause of hypertension other than primary aldosteronism Severe nocturnal hypoxemia (O2 desaturation nadir <60%) White coat hypertension defined as office BP >140/90 mm Hg and ambulatory daytime BP <135/85 mm Hg Central sleep apnea (defined as 5% or more of the apneas as central apneas) and/or the presence of any Cheyne-Stokes breathing Subjects working shift work or having other known circadian rhythm disorders such that their sleep-wake schedule is altered Excessive daytime sleepiness as indicated by an Epworth score of >10 Pregnant Women
Facility Information:
Facility Name
University of Alabama at Birmingham
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35294
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20016520
Citation
Gaddam K, Pimenta E, Thomas SJ, Cofield SS, Oparil S, Harding SM, Calhoun DA. Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report. J Hum Hypertens. 2010 Aug;24(8):532-7. doi: 10.1038/jhh.2009.96. Epub 2009 Dec 17.
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Etiology of Sleep Apnea-related Hyperaldosteronism - BP Treatment

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