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Safety and Tolerability of Azilsartan Medoxomil Plus Chlorthalidone Compared to Olmesartan Medoxomil Plus Hydrochlorothiazide in Participants With Essential Hypertension

Primary Purpose

Essential Hypertension

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Azilsartan medoxomil and chlorthalidone
Olmesartan medoxomil and hydrochlorothiazide
Sponsored by
Takeda
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Essential Hypertension focused on measuring Hypertensive, Blood Pressure, High, Cardiovascular disease, Vascular Disease, Drug Therapy

Eligibility Criteria

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

Inclusion Criteria:

  • Is treated with antihypertensive therapy and has a post-washout mean sitting clinic systolic blood pressure greater than or equal to 160 and less than or equal to 190 mm Hg on Day, or has not received antihypertensive treatment within 14 days prior to Screening and has a mean sitting clinic systolic blood pressure greater than or equal to 160 and less than or equal to 190 mm Hg at the Screening Visit and on Day 1.
  • Females of childbearing potential who are sexually active agree to routinely use adequate contraception, and can neither be pregnant nor lactating from before study participation to Screening to 30 days after the last study drug dose.
  • Has clinical laboratory test results within the reference range for the testing laboratory or the investigator does not consider the results to be clinically significant.
  • Is willing to discontinue current antihypertensive medications up to 3 weeks before enrollment.

Exclusion Criteria:

  • Has a mean clinic diastolic blood pressure (sitting, trough) greater than 119 mm Hg on Day 1.
  • Has secondary hypertension of any etiology (eg, renovascular disease, pheochromocytoma, Cushing's syndrome).
  • Has a recent history (within the last 6 months) of myocardial infarction, heart failure, unstable angina, coronary artery bypass graft, percutaneous coronary intervention, hypertensive encephalopathy, cerebrovascular accident or transient ischemic attack.
  • Has clinically significant cardiac conduction defects (ie, third-degree atrioventricular block, sick sinus syndrome).
  • Has hemodynamically significant left ventricular outflow obstruction due to aortic valvular disease.
  • Has severe renal dysfunction or disease.
  • Has known or suspected unilateral or bilateral renal artery stenosis.
  • Has a history of cancer that has not been in remission for at least 5 years prior to the first dose of study drug.
  • Has poorly-controlled type 1 or 2 diabetes mellitus at Screening.
  • Has hypokalemia or hyperkalemia at Screening.
  • Has an alanine aminotransferase or aspartate aminotransferase level of greater than 2.5 times the upper limit of normal, active liver disease, or jaundice at Screening.
  • Has any other known serious disease or condition that would compromise safety, might affect life expectancy, or make it difficult to successfully manage and follow according to the protocol.
  • Has known hypersensitivity to angiotensin II receptor blockers or thiazide-type diuretics or other sulfonamide-derived compounds.
  • Has been randomized/enrolled in a previous azilsartan or azilsartan medoxomil plus chlorthalidone study.
  • Currently is participating in another investigational study or has received any investigational compound within 30 days prior to Screening.
  • Has a history of drug abuse or a history of alcohol abuse within the past 2 years.
  • Is taking or expected to take any excluded medication, including:

    • Antihypertensive medications must be discontinued completely by Day -14, except antihypertensive medications used in the open-label treatment period in accordance with the titration-to-target blood pressure titration.
    • Angiotensin II receptor blockers or thiazide-type diuretics other than study medication.
    • Over-the-counter products not permitted by investigator.

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Azilsartan Medoxomil and Chlorthalidone

Olmesartan Medoxomil and Hydrochlorothiazide QD

Arm Description

Azilsartan medoxomil 40 mg and chlorthalidone 12.5 mg combination tablet, orally, once daily for up to 52 weeks. For participants who did not achieve target blood pressure by Week 4, titration to a maximum dose of azilsartan medoxomil 80 mg and chlorthalidone 25 mg.

Participants in the United States: Olmesartan medoxomil 20 mg and hydrochlorothiazide 12.5 mg combination tablet, orally, once daily for up to 52 weeks. For participants who did not achieve target blood pressure by Week 4, titration to a maximum dose of Olmesartan medoxomil 40 mg and hydrochlorothiazide 25 mg. Participants in Europe: Olmesartan medoxomil 20 mg and hydrochlorothiazide 12.5 mg combination tablet, orally, once daily for up to 52 weeks. For participants who did not achieve target blood pressure by Week 4, titration to a maximum dose of Olmesartan medoxomil 20 mg and hydrochlorothiazide 25 mg.

Outcomes

Primary Outcome Measures

Percentage of Participants With at Least 1 Adverse Event
An adverse event is defined as any untoward medical occurrence in a clinical investigation participant administered a pharmaceutical product without regard to causality.

Secondary Outcome Measures

Percentage of Participants With Serum Creatinine Elevations Greater Than 50% From Baseline and Greater Than the Upper Limit of Normal (ULN)
Serum creatinine was measured at every visit and evaluated as a laboratory parameter of special interest. The percentage of participants with creatinine increase ≥50% from Baseline and greater than ULN was summarized: - At any visit (includes transient and persistent elevations). - At the Final Visit (includes persistent elevations and participants whose first elevation may have been at the Final Visit). - At least 2 consecutive visits (includes only persistent elevations).

Full Information

First Posted
October 12, 2009
Last Updated
October 15, 2012
Sponsor
Takeda
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1. Study Identification

Unique Protocol Identification Number
NCT00996281
Brief Title
Safety and Tolerability of Azilsartan Medoxomil Plus Chlorthalidone Compared to Olmesartan Medoxomil Plus Hydrochlorothiazide in Participants With Essential Hypertension
Official Title
A Phase 3, Open-Label, Randomized, Long-Term Comparison of the Safety and Tolerability of the TAK-491 Plus Chlorthalidone Fixed-Dose Combination vs. Olmesartan Medoxomil-Hydrochlorothiazide Fixed-Dose Combination in Subjects With Essential Hypertension
Study Type
Interventional

2. Study Status

Record Verification Date
October 2012
Overall Recruitment Status
Completed
Study Start Date
October 2009 (undefined)
Primary Completion Date
November 2011 (Actual)
Study Completion Date
November 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Takeda

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to compare the safety and tolerability of azilsartan medoxomil plus chlorthalidone, once daily (QD), versus olmesartan medoxomil-hydrochlorothiazide in adults with essential hypertension.
Detailed Description
High Blood Pressure (Hypertension) is the most common cause of preventable death in developed nations. Uncontrolled hypertension greatly increases the risk of heart disease, brain disease, and kidney failure. As the population ages, the incidence of hypertension will continue to increase if effective preventive measures are not implemented. Despite the availability of antihypertensive agents, hypertension is not adequately controlled; only about one in three patients successfully keep blood pressure normal. Treatment for high blood pressure includes thiazides or thiazide-like diuretics, either alone or as part of combination treatment. Chlorthalidone is a commercially available, orally administered thiazide-type diuretic agent. TAK-491 (azilsartan) is an angiotensin II receptor blocker being evaluated by Takeda to treat patients with high blood pressure (essential hypertension). This study will compare the safety and tolerability of azilsartan medoxomil plus chlorthalidone (TAK-491CLD) fixed-dose combination to olmesartan medoxomil-hydrochlorothiazide fixed-dose combination. Initially patients will undergo a Screening Visit to confirm that they are eligible to participate in the study. All participants will receive the study drug for up to 52 weeks. The dose of the study drug may be gradually increased throughout the study so that a target blood pressure value can be reached for each participant. Throughout the treatment period of the study, participants will be required to visit the research site for 11 visits. At these study visits participants will be required to undergo certain study procedures including physical examinations, vital sign measurements (blood pressure, heart rate, weight and height), electrocardiograms (monitoring of the heart), and blood and urine samples taken for clinical laboratory tests.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Essential Hypertension
Keywords
Hypertensive, Blood Pressure, High, Cardiovascular disease, Vascular Disease, Drug Therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
837 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Azilsartan Medoxomil and Chlorthalidone
Arm Type
Experimental
Arm Description
Azilsartan medoxomil 40 mg and chlorthalidone 12.5 mg combination tablet, orally, once daily for up to 52 weeks. For participants who did not achieve target blood pressure by Week 4, titration to a maximum dose of azilsartan medoxomil 80 mg and chlorthalidone 25 mg.
Arm Title
Olmesartan Medoxomil and Hydrochlorothiazide QD
Arm Type
Active Comparator
Arm Description
Participants in the United States: Olmesartan medoxomil 20 mg and hydrochlorothiazide 12.5 mg combination tablet, orally, once daily for up to 52 weeks. For participants who did not achieve target blood pressure by Week 4, titration to a maximum dose of Olmesartan medoxomil 40 mg and hydrochlorothiazide 25 mg. Participants in Europe: Olmesartan medoxomil 20 mg and hydrochlorothiazide 12.5 mg combination tablet, orally, once daily for up to 52 weeks. For participants who did not achieve target blood pressure by Week 4, titration to a maximum dose of Olmesartan medoxomil 20 mg and hydrochlorothiazide 25 mg.
Intervention Type
Drug
Intervention Name(s)
Azilsartan medoxomil and chlorthalidone
Other Intervention Name(s)
TAK-491CLD
Intervention Description
Combination tablet.
Intervention Type
Drug
Intervention Name(s)
Olmesartan medoxomil and hydrochlorothiazide
Other Intervention Name(s)
Benicar HCT®, Olmetec Plus®
Intervention Description
Combination tablet.
Primary Outcome Measure Information:
Title
Percentage of Participants With at Least 1 Adverse Event
Description
An adverse event is defined as any untoward medical occurrence in a clinical investigation participant administered a pharmaceutical product without regard to causality.
Time Frame
From Week 0 (Day 1) to Week 52.
Secondary Outcome Measure Information:
Title
Percentage of Participants With Serum Creatinine Elevations Greater Than 50% From Baseline and Greater Than the Upper Limit of Normal (ULN)
Description
Serum creatinine was measured at every visit and evaluated as a laboratory parameter of special interest. The percentage of participants with creatinine increase ≥50% from Baseline and greater than ULN was summarized: - At any visit (includes transient and persistent elevations). - At the Final Visit (includes persistent elevations and participants whose first elevation may have been at the Final Visit). - At least 2 consecutive visits (includes only persistent elevations).
Time Frame
Baseline and Week 52

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Is treated with antihypertensive therapy and has a post-washout mean sitting clinic systolic blood pressure greater than or equal to 160 and less than or equal to 190 mm Hg on Day, or has not received antihypertensive treatment within 14 days prior to Screening and has a mean sitting clinic systolic blood pressure greater than or equal to 160 and less than or equal to 190 mm Hg at the Screening Visit and on Day 1. Females of childbearing potential who are sexually active agree to routinely use adequate contraception, and can neither be pregnant nor lactating from before study participation to Screening to 30 days after the last study drug dose. Has clinical laboratory test results within the reference range for the testing laboratory or the investigator does not consider the results to be clinically significant. Is willing to discontinue current antihypertensive medications up to 3 weeks before enrollment. Exclusion Criteria: Has a mean clinic diastolic blood pressure (sitting, trough) greater than 119 mm Hg on Day 1. Has secondary hypertension of any etiology (eg, renovascular disease, pheochromocytoma, Cushing's syndrome). Has a recent history (within the last 6 months) of myocardial infarction, heart failure, unstable angina, coronary artery bypass graft, percutaneous coronary intervention, hypertensive encephalopathy, cerebrovascular accident or transient ischemic attack. Has clinically significant cardiac conduction defects (ie, third-degree atrioventricular block, sick sinus syndrome). Has hemodynamically significant left ventricular outflow obstruction due to aortic valvular disease. Has severe renal dysfunction or disease. Has known or suspected unilateral or bilateral renal artery stenosis. Has a history of cancer that has not been in remission for at least 5 years prior to the first dose of study drug. Has poorly-controlled type 1 or 2 diabetes mellitus at Screening. Has hypokalemia or hyperkalemia at Screening. Has an alanine aminotransferase or aspartate aminotransferase level of greater than 2.5 times the upper limit of normal, active liver disease, or jaundice at Screening. Has any other known serious disease or condition that would compromise safety, might affect life expectancy, or make it difficult to successfully manage and follow according to the protocol. Has known hypersensitivity to angiotensin II receptor blockers or thiazide-type diuretics or other sulfonamide-derived compounds. Has been randomized/enrolled in a previous azilsartan or azilsartan medoxomil plus chlorthalidone study. Currently is participating in another investigational study or has received any investigational compound within 30 days prior to Screening. Has a history of drug abuse or a history of alcohol abuse within the past 2 years. Is taking or expected to take any excluded medication, including: Antihypertensive medications must be discontinued completely by Day -14, except antihypertensive medications used in the open-label treatment period in accordance with the titration-to-target blood pressure titration. Angiotensin II receptor blockers or thiazide-type diuretics other than study medication. Over-the-counter products not permitted by investigator.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Executive Medical Director, Clinical Science
Organizational Affiliation
Takeda
Official's Role
Study Director
Facility Information:
City
Graz
State/Province
Styria
Country
Austria
City
Karlsruhe
State/Province
Baden-Wurttemberg
Country
Germany
City
Hannover
State/Province
Lower Saxony
Country
Germany
City
Kiel-Kronshagen
State/Province
Schleswig-Holstein
Country
Germany
City
Breda
State/Province
North Brabant
Country
Netherlands
City
Eindhoven
State/Province
North Brabant
Country
Netherlands
City
Amsterdam
State/Province
North Holland
Country
Netherlands
City
Velp
State/Province
Rheden
Country
Netherlands
City
Leiderdorp
State/Province
South Holland
Country
Netherlands
City
Zoetermeer
State/Province
South Holland
Country
Netherlands
City
Rotterdam
State/Province
Zuid-Holland
Country
Netherlands
City
Groningen
Country
Netherlands
City
Bydgoszcz
State/Province
Kuyavian-Pomeranian
Country
Poland
City
Skierniewice
State/Province
L0dz
Country
Poland
City
Zgierz
State/Province
L0dz
Country
Poland
City
Gdansk
State/Province
Pomeranian
Country
Poland
City
Gdynia
State/Province
Pomeranian
Country
Poland
City
Sopot
State/Province
Pomeranian
Country
Poland
City
Mikolow
State/Province
Silesian
Country
Poland
City
Avon
State/Province
England
Country
United Kingdom
City
Bolton
State/Province
England
Country
United Kingdom
City
Chorley
State/Province
England
Country
United Kingdom
City
Inverness
State/Province
England
Country
United Kingdom
City
Liverpool
State/Province
England
Country
United Kingdom
City
Surrey
State/Province
England
Country
United Kingdom
City
Warwickshire
State/Province
England
Country
United Kingdom

12. IPD Sharing Statement

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Safety and Tolerability of Azilsartan Medoxomil Plus Chlorthalidone Compared to Olmesartan Medoxomil Plus Hydrochlorothiazide in Participants With Essential Hypertension

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