Spironolactone Combined With Captopril and Carvedilol for the Treatment of Pulmonary Arterial Hypertension

This study has been completed.
Sponsor:
Information provided by:
Hebei Medical University
ClinicalTrials.gov Identifier:
NCT00240656
First received: October 17, 2005
Last updated: June 27, 2008
Last verified: October 2005

October 17, 2005
June 27, 2008
October 2005
Not Provided
  • Dyspnoea score
  • Exercise capacity (six-minute walk)
  • NYHA/WHO functional class
  • Change of acropachy
  • Blood gas test
  • Pulmonary artery pressure (measured by echocardiogram or catheter)
  • 1. Change of acropachy
  • 2. Blood gas test
  • 3. Pulmonary artery pressure (measured by echocardiogram or catheter)
Complete list of historical versions of study NCT00240656 on ClinicalTrials.gov Archive Site
  • Other echocardiographic changes:
  • Systolic pulmonary arterial pressure
  • Change of right to left shunt expressed by time-velocity integral (TVI) from the defect
  • Change of left to right shunt expressed by TVI from the defect
  • Right ventricular (RV) acceleration time (ms)
  • RV ejection time (ms)
  • Ratio of RV ejection time/RV acceleration time
  • Pulmonary arterial valve TVI
  • Change of diameters of both left and right ventricles
  • Change of diameters of both left and right atrium
  • Doppler mitral valve (MV) TVI
  • Blood gas test
  • Other echocardiographic changes:
  • Systolic pulmonary arterial pressure
  • Change of right to left shunt expressed by time-velocity integral (TVI) from the defect
  • Change of left to right shunt expressed by TVI from the defect
  • Right ventricular (RV) acceleration time (ms)
  • RV ejection time (ms)
  • Ratio of RV ejection time/RV acceleration time
  • Pulmonary arterial valve TVI
  • Change of diameters of both left and right ventricles
  • Change of diameters of both left and right atrium
  • Doppler mitral valve (MV) TVI
  • Blood gas test
  • Dyspnoea score
  • Exercise capacity (six-minute walk)
  • NYHA/WHO functional class
Not Provided
Not Provided
 
Spironolactone Combined With Captopril and Carvedilol for the Treatment of Pulmonary Arterial Hypertension
Official Title: Spironolactone Combined With Captopril and Carvedilol for the Treatment of Patients With Pulmonary Arterial Hypertension Associated With Congenital Heart Disease—Focus on Pulmonary Artery Remodeling

The purpose of this study is to determine whether a larger dose of the aldosterone antagonist spironolactone combined with an ACE inhibitor (captopril) and a beta-blocker (carvedilol) is effective in reverse pulmonary artery remodeling in patients with pulmonary arterial hypertension (PAH)secondary to congenital heart disease

The pathogenesis of PAH involves multiple mechanisms. However, three common factors are thought to cause the increased pulmonary vascular resistance that characterizes this devastating disease: vasoconstriction, pulmonary vascular proliferation and remodeling, and thrombosis in situ. Advances in our knowledge of the molecular mechanisms involved in PAH suggest that endothelial dysfunction with chronic impaired production of vasoactive mediators plays a key role. Reduced production of vasoactive mediators, such as nitric oxide (NO) and prostacyclin, along with prolonged overexpression of vasoconstrictors such as endothelin-1 (ET-1), not only affect vascular tone but also promote vascular remodeling. Thus, these substances represent logical pharmacological targets. Animal studies showed ET-1 could stimulate aldosterone secretion in different species, both in vivo and in vitro. This stimulation involves the ET-B alone and both ET-A and ET-B receptor subtypes in rats and humans. Animal studies also showed spironolactone combined with ACE inhibitor could normalize blood pressure, prevents upregulation of vascular ET-1, restore nitric oxide (NO)-mediated endothelial dysfunction. Beta-blockers have ability to reduce dp/dt in pulmonary artery, as well as left ventricle, thus prevent further damage to the dysfunctional endothelium. Furthermore, we observed from our practice that the aforementioned therapy could lower pulmonary artery pressure in patents with pulmonary hypertension secondary to left ventricular dysfunction. Thus, we hypothesize spironolactone combined with ACE inhibitor and beta-blocker has the ability to reverse remodeling of pulmonary artery in PAH patients.

Interventional
Phase 1
Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Hypertension, Pulmonary
Drug: spironolactone captopril carvedilol
Not Provided
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*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
Not Provided
May 2006
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Inclusion Criteria:

  • A mean pulmonary artery pressure higher than 25 mm Hg or, when estimated by echocardiography, pulmonary artery pressure more than half the systemic artery pressure
  • Congenital systemic-to-pulmonary shunts
Both
up to 80 Years
No
Contact information is only displayed when the study is recruiting subjects
China
 
NCT00240656
0510-A
Not Provided
Not Provided
Hebei Medical University
Not Provided
Study Chair: Kunshen Liu, M.D. Hebei Medical University First Hospital
Hebei Medical University
October 2005

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP