Study of High Dosage of Losartan in Comparison to Low Dose of Losartan in Heart Failure Patients
Primary Purpose
Heart Failure
Status
Withdrawn
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
Low dose losartan
High dose losartan
Sponsored by
About this trial
This is an interventional treatment trial for Heart Failure focused on measuring Heart failure, Losartan
Eligibility Criteria
Inclusion Criteria:
- Males and females age between 21 and 75 years
- Diagnosis of mild to moderate congestive heart failure
- Coronary angiography identifying coronary artery disease as the likely cause of congestive heart failure
- Left Ventricular (LV) ejection fraction between 20 to 40 percent on echocardiography or RNA
- Sinus rhythm
Exclusion Criteria:
- Insulin-dependent diabetes mellitus
- Hypertension (higher than 140/90 mmHg at rest)
- Use of sympatholytic agents such as clonidine, methyldopa, reserpine
- Significant non-cardiac disease, possibly affecting cardiovascular regulation
- Autonomic neuropathy of any cause
- Leg injuries with nerve damage
- Poor bladder control
- Recent history of alcoholism, drug abuse, significant psychiatric disorders
- Known adverse events to AT1-receptor blockers
- Unlikely to tolerate being off digoxin and off blockers of the RAS for a short period
- Ischemic event within past 3 months
- Serum creatinine higher than 200 mmol/L
- Patients taking digoxin for atrial fibrillation
- Patients who require treatment with aldactone
- Patients with more than mild stable angina while on beta-blockers and/or calcium antagonists
- Patients on coumadin
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Active Comparator
Arm Label
Low dose losartan
High dose losartan
Arm Description
Low dose losartan
High dose losartan
Outcomes
Primary Outcome Measures
Effect of losartan on the sympathetic nervous system.
Assessed by microneurographic recordings of muscle sympathetic nerve activity from the peroneal nerve.
Secondary Outcome Measures
Change in plasma catecholamines.
Plasma catecholamines will be measured by High-performance liquid chromatography (HPLC). Samples will be collected for plasma aldosterone, plasma renin and plasma angiotensin II.
Change in central hemodynamics.
Invasive measurement of central hemodynamic parameters; heart rate, blood pressure, cardiac output (CO), pulmonary capillary wedge pressure (PCWP), right arterial pressure (RAP).
Full Information
NCT ID
NCT02238457
First Posted
June 4, 2012
Last Updated
November 1, 2018
Sponsor
Baker Heart and Diabetes Institute
1. Study Identification
Unique Protocol Identification Number
NCT02238457
Brief Title
Study of High Dosage of Losartan in Comparison to Low Dose of Losartan in Heart Failure Patients
Official Title
Effects of Low-Dose vs High-dose Losartan on Sympathetic Hyperactivity in Patients With Congestive Heart Failure
Study Type
Interventional
2. Study Status
Record Verification Date
November 2018
Overall Recruitment Status
Withdrawn
Why Stopped
Difficulty recruiting patients
Study Start Date
undefined (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
undefined (undefined)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Baker Heart and Diabetes Institute
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
The sympathetic nervous system, a part of the nervous system that stimulates the heart via release of substances, noradrenaline and adrenaline (combined called catecholamines), becomes activated in people with heart failure. As these people become sicker, the nervous system becomes more active, causing further damage to the heart.
Large trials have shown that Angiotensin-converting enzyme (ACE) inhibitors reduce morbidity and mortality in patients with heart failure. Higher doses of these drugs are more effective than lower doses. Studies show that ACE-inhibitors decrease catecholamine levels. This could be why congestive heart failure (CHF) patients taking this class of drugs show improvement in heart function.
There are several ways of measuring the activity of the sympathetic nervous system. The most common measurement is to test the blood for catecholamine levels. This is not very reliable or reproducible. Microneurography is a new technique used to measure sympathetic nerve activity. A small electrode (comparable to an acupuncture needle) is placed in a muscle nerve and hooked up to a stimulator and a recorder. It produces direct recordings of skeletal muscle nerve traffic. Both the rate and amplitude of the burst can be measured. The results in this technique are highly reproducible. By using this technique we get a more accurate picture of how the nervous system responds to medications given to treat heart failure.
Losartan (Cozaar) is an angiotensin II type 1 (AT1) receptor blocker. It blocks the binding of angiotensin II, a hormone that constricts blood vessels. As a result the blood vessels remain relaxed, leading to a reduction in the workload of the heart. Minor decreases in blood catecholamine levels have been reported with a low dose of this drug. The purpose of this study is to see whether a high dose of losartan (200 mg) has a greater effect on the sympathetic nervous system than a low dose of losartan (50 mg) does.
A total of 30 participants will be recruited. Participants will be assigned to one of two groups: high-dose, in which subjects will receive treatment of 200 mg/day of losartan, and low-dose, in which subjects will receive treatment of 50 mg/day of losartan. Via microneurography the investigators will measure the difference in sympathetic activity in subjects in high-dose vs low-dose losartan. The investigators expect to see further decrease in sympathetic activity in high-dose group than in low-dose group.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Heart Failure
Keywords
Heart failure, Losartan
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
Participant
Allocation
Randomized
Enrollment
0 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Low dose losartan
Arm Type
Active Comparator
Arm Description
Low dose losartan
Arm Title
High dose losartan
Arm Type
Active Comparator
Arm Description
High dose losartan
Intervention Type
Drug
Intervention Name(s)
Low dose losartan
Other Intervention Name(s)
losartan (Cozaar)
Intervention Description
25 mg losartan bid for 10 weeks
Intervention Type
Drug
Intervention Name(s)
High dose losartan
Other Intervention Name(s)
Losartan (Cozaar)
Intervention Description
50 mg, 75 mg, or 100 mg bid for 10 weeks. Dose will be determined by the medical doctor depending on patients' tolerability
Primary Outcome Measure Information:
Title
Effect of losartan on the sympathetic nervous system.
Description
Assessed by microneurographic recordings of muscle sympathetic nerve activity from the peroneal nerve.
Time Frame
10 weeks
Secondary Outcome Measure Information:
Title
Change in plasma catecholamines.
Description
Plasma catecholamines will be measured by High-performance liquid chromatography (HPLC). Samples will be collected for plasma aldosterone, plasma renin and plasma angiotensin II.
Time Frame
10 weeks
Title
Change in central hemodynamics.
Description
Invasive measurement of central hemodynamic parameters; heart rate, blood pressure, cardiac output (CO), pulmonary capillary wedge pressure (PCWP), right arterial pressure (RAP).
Time Frame
10 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Males and females age between 21 and 75 years
Diagnosis of mild to moderate congestive heart failure
Coronary angiography identifying coronary artery disease as the likely cause of congestive heart failure
Left Ventricular (LV) ejection fraction between 20 to 40 percent on echocardiography or RNA
Sinus rhythm
Exclusion Criteria:
Insulin-dependent diabetes mellitus
Hypertension (higher than 140/90 mmHg at rest)
Use of sympatholytic agents such as clonidine, methyldopa, reserpine
Significant non-cardiac disease, possibly affecting cardiovascular regulation
Autonomic neuropathy of any cause
Leg injuries with nerve damage
Poor bladder control
Recent history of alcoholism, drug abuse, significant psychiatric disorders
Known adverse events to AT1-receptor blockers
Unlikely to tolerate being off digoxin and off blockers of the RAS for a short period
Ischemic event within past 3 months
Serum creatinine higher than 200 mmol/L
Patients taking digoxin for atrial fibrillation
Patients who require treatment with aldactone
Patients with more than mild stable angina while on beta-blockers and/or calcium antagonists
Patients on coumadin
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Markus P Schlaich
Organizational Affiliation
Baker IDI Heart & Diabetes Institute
Official's Role
Principal Investigator
12. IPD Sharing Statement
Learn more about this trial
Study of High Dosage of Losartan in Comparison to Low Dose of Losartan in Heart Failure Patients
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