Beta Blockers and Angiotensin Receptor Blockers in Bicuspid Aortic Valve Disease Aortopathy (BAV Study)
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Purpose
The purpose of this study is to determine whether long-term treatment with a beta-blocker (BB) such as atenolol and/or an angiotensin receptor blocker (ARB) such as telmisartan, given to adult patients with bicuspid aortic valve (BAV) disease (aortopathy) reduces the widening (dilatation) of the aorta from its baseline size.
| Condition | Intervention | Phase |
|---|---|---|
|
Cardiac Disease |
Drug: Atenolol Drug: Telmisartan |
Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Prevention |
| Official Title: | Beta Blockers and Angiotensin Receptor Blockers in Bicuspid Aortic Valve Disease Aortopathy (BAV Study) |
- Change from baseline in ascending aorta size, as evaluated by MRI [ Time Frame: Baseline, Year 3, Year 5 ] [ Designated as safety issue: No ]The primary analyses include the evaluation of the effects of monotherapy (atenolol vs. placebo, telmisartan vs. placebo; the margins of the factorial design) and of combination therapy (atenolol plus telmisartan vs. double placebo) on the change in aortic root size measured at baseline, 3 years and 5 years.
- Rate of change in ascending aorta size evaluated by transthoracic echocardiography (TEE). [ Time Frame: Baseline, Year 1, year 2, Year 3, Year 4 and Final ] [ Designated as safety issue: No ]
| Estimated Enrollment: | 416 |
| Study Start Date: | June 2011 |
| Estimated Study Completion Date: | July 2016 |
| Estimated Primary Completion Date: | April 2016 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Atenolol
Atenolol or matching placebo 25 mg up-titrated to 100 mg.
|
Drug: Atenolol
Atenolol or matching placebo 25 mg up-titrated to 100 mg
Other Names:
|
|
Experimental: Telmisartan
Telmisartan or matching placebo 40 mg up-titrated to 80mg
|
Drug: Telmisartan
Telmisartan or matching placebo 40 mg up-titrated to 80mg.
Other Names:
|
Detailed Description:
Bicuspid aortic valve (BAV) is the most common congenital heart disease lesion with an estimated 280 000 to 560 000 people affected in the Canada. Dilatation of the ascending aorta is a common feature in patients with BAV and is a result of inherent vascular abnormalities with superimposed effects of age and acquired cardiovascular risk factors. Severe aortic dilatation (> 50mm) leads to aortic dissection and premature death.
Histopathological studies of the aortas in patients with BAVs report similar findings to that of patients with Marfan syndrome. Beta Blocker (BB) therapy and more recently, Angiotensin Receptor Blocker (ARB) therapy, have been shown to decrease to rate of aortic dilatation and be of benefit to patients with Marfan syndrome. There is no such data however in patients with BAV and aortopathy.
Within the context of a randomized clinical trial, the investigators proposed to test the hypothesis that BB or ARB will reduce the rate of progressive aortic dilatation in adults with BAVs and ascending aortopathy as compared to placebo.
Design: Multicentre, randomized, double-blind, placebo-controlled, trial of adult patients with bicuspid aortic valve aortopathy. Patients who are eligible to take either study medication will be randomly allocated to participate in either the BB (atenolol) vs. placebo arm, or the ARB (telmisartan) vs. placebo arm. Patients who are ineligible for the BB arm will be assigned to the ARB vs. placebo arm and patients who are ineligible for the ARB arm will be assigned to the BB vs. placebo arm. Within each arm, all participants will be randomized to take either placebo or active medication. The atenolol arm will be up-titrated to100mg/day and the telmisartan arm will be up-titrated to 80 mg/day, or to the maximum tolerated dose.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Age => 18 years
- Men and women with BAV and ascending aorta measuring > 37mm.
- Written informed consent
General Study Exclusion Criteria
History of cardiac diseases, such as
- Symptomatic aortic stenosis or aortic regurgitation referred for surgical intervention or asymptomatic severe aortic stenosis or regurgitation based on current guidelines
- Uncontrolled heart failure, right ventricular failure due to pulmonary hypertension
- Cardiogenic shock
- Systolic blood pressure < 100 mmHg
- History of drug sensitivity, contraindication or adverse reaction to both BB and ARB. Participants who are able to tolerate only a BB will be allocated to the BB vs. placebo arm, and participants who are able to tolerate only an ARB will be allocated to the ARB vs. placebo arm, assuming no other exclusion criteria are met.
- Ascending aorta measuring ≥ 50mm, requiring prophylactic ascending aorta surgery
- Unable to provide informed consent
- Need for both BB and ARB for treatment of concomitant medical conditions for which there are no other alternatives. Participants who are taking an ARB which cannot be discontinued will be allocated to the BB arm, and participants who are taking a BB which cannot be discontinued will be allocated to the ARB arm, if no other exclusion criteria are met.
- Prior surgery on ascending aorta or aortic root (balloon valvuloplasty, aortic valvotomy or post coarctation surgery are acceptable)
- Women who are pregnant at screening visit
- Contraindication to MRI (claustrophobia, pacemaker, metallic clip in eye or brain)
- History of any illness which limits the participants' ability to complete the study
Additional Exclusion Criteria for BB arm only
- Heart rate <60 bpm
- Heart block (1st, 2nd and 3rd degree AV block on ECG), or sick sinus syndrome
- Asthma of sufficient severity to represent a contraindication to BB use in the judgment of the patient's physician
- History of severe peripheral artery disorders
- History of pheochromocytoma without the use of alpha-adrenergic blockers
- History of metabolic acidosis
Additional Exclusion Criteria for ARB arm only
- Women who are pregnant, lactating or who intend to become pregnant during the course of the study
- Women who are of childbearing age and are not on reliable, accepted form of birth control
- Hyperkalemia [serum potassium > 5.5 mmol/L] or renal dysfunction [GFR<45% measured by MDRD)
- Patients being treated with an ACE Inhibitor that cannot be discontinued. (These patients may be randomized in the BB arm if no exclusion criteria are met.)
- History of bilateral renal artery stenosis or unilateral renal artery stenosis to a solitary kidney
- History of hepatic insufficiency and hepato-biliary obstruction
- History of fructose intolerance
Contacts and Locations| Contact: Tara McCready, PhD | 905-527-4322 ext 40439 | tara.mccready@phri.ca |
| Contact: Parvez Khatib | 905-527-4322 ext 40550 | parvez.khatib@phri.ca |
| Canada, Alberta | |
| Mazankowski Alberta Heart Institute | Recruiting |
| Edmonton, Alberta, Canada, T6G 2B7 | |
| Principal Investigator: Isabelle VonderMuhll | |
| Canada, British Columbia | |
| University of British Columbia | Recruiting |
| Vancouver, British Columbia, Canada, V6Z 1Y6 | |
| Principal Investigator: Jasmine Grewal | |
| Canada, Manitoba | |
| St. Boniface Hospital | Recruiting |
| Winnipeg, Manitoba, Canada | |
| Principal Investigator: James Tam | |
| Canada, Ontario | |
| Population Health Research Institute - Coordinating Centre | Active, not recruiting |
| Hamilton, Ontario, Canada, L8L2X2 | |
| Hamilton Health Sciences-General | Recruiting |
| Hamilton, Ontario, Canada, L8L 2X2 | |
| Principal Investigator: Omid Salehian | |
| London Health Sciences Centre | Recruiting |
| London, Ontario, Canada, N6A 5A5 | |
| Principal Investigator: Samuel Siu | |
| Toronto General Hospital/University of Toronto | Recruiting |
| Toronto, Ontario, Canada | |
| Principal Investigator: Candice Silversides | |
| Canada, Quebec | |
| Jewish General Hospital | Recruiting |
| Montreal, Quebec, Canada, H3T 1E2 | |
| Principal Investigator: Judith Therrien | |
| McGill University Health Centre | Recruiting |
| Montreal, Quebec, Canada, H3A 1A1 | |
| Principal Investigator: Judith Therrien | |
| Principal Investigator: | Judith Therrien, MD | MdGill University |
More Information
No publications provided
| Responsible Party: | Hamilton Health Sciences Corporation |
| ClinicalTrials.gov Identifier: | NCT01202721 History of Changes |
| Other Study ID Numbers: | BAV-15JUNE2010 |
| Study First Received: | September 14, 2010 |
| Last Updated: | November 23, 2012 |
| Health Authority: | Canada: Health Canada |
Keywords provided by Hamilton Health Sciences Corporation:
|
Congenital Aortic Valve Bicuspid Aortopathy bicuspid aortic valve aortopathy |
Additional relevant MeSH terms:
|
Heart Diseases Cardiovascular Diseases Adrenergic beta-Antagonists Atenolol Telmisartan Angiotensin Receptor Antagonists Adrenergic Antagonists Adrenergic Agents Neurotransmitter Agents Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Physiological Effects of Drugs |
Anti-Arrhythmia Agents Cardiovascular Agents Therapeutic Uses Antihypertensive Agents Sympatholytics Autonomic Agents Peripheral Nervous System Agents Adrenergic beta-1 Receptor Antagonists Angiotensin II Type 1 Receptor Blockers Angiotensin-Converting Enzyme Inhibitors Protease Inhibitors Enzyme Inhibitors |
ClinicalTrials.gov processed this record on May 23, 2013