Modulating Effects of Lisinopril on Sildenafil Activity in Pulmonary Arterial Hypertension(PAH)( MELISSA) (MELISSA)

Study Description

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Brief Summary:

Patients with pulmonary arterial hypertension(PAH) suffer from chronic shortness of breath, and have impaired survival related to progressive right ventricular failure. Abnormal vasoreactivity to nitric oxide(NO) plays a role in the pathophysiology of PAH. Phosphodiesterase Type 5 Inhibitor (PDE5 inhibitors) sildenafil have been shown to be beneficial in PAH, but extent of benefit is variable.

Condition or disease
Pulmonary Arterial Hypertension

Detailed Description:

The broad aim of this investigation is to determine whether the modulating effect of angiotensin converting enzyme inhibition on vascular smooth muscle responsiveness to the nitric oxide pathway that we have observed in an animal model of Congestive Heart Failure(CHF) can be exploited in humans with PAH. Furthermore, we have identified a group of genes TAO kinase I, IL-10, Rho kinase, Raf1, bile acid coenzyme A and Fmr1 that are modulated by long-acting angiotensin-converting enzyme inhibitor (ACEI) in our animal model, and therefore may also be modulated by ACEI in patients with PAH

Study Design

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Study Type :	Observational
Actual Enrollment :	24 participants
Observational Model:	Cohort
Time Perspective:	Prospective
Official Title:	Modulating Effects of Lisinopril on Sildenafil Activity in PAH (MELISSA)
Study Start Date :	May 2008
Actual Primary Completion Date :	July 2011
Actual Study Completion Date :	July 2011

Groups and Cohorts

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Group/Cohort
Lisinopril; Participants will be randomized 2 to 1 to receive drug versus placebo.

Outcome Measures

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Primary Outcome Measures :

1. The primary aim of the pilot study is to assess feasibility and tolerability. [ Time Frame: 32 weeks ]

Secondary Outcome Measures :

1. Demonstrate tolerability of long-acting angiotensin-converting enzyme inhibitor (ACEI) therapy in this patient cohort [ Time Frame: 32 weeks ]
2. Demonstrate whether long-acting angiotensin-converting enzyme inhibitor (ACEI) in Pulmonary Arterial Hypertension (PAH) pts on sildenafil modifies regulation of the genes. [ Time Frame: 32 weeks ]
3. Demonstrate whether ACEI in PAH pts on sildenafil reduces N-BNP levels, a marker of disease severity [ Time Frame: 32 weeks ]
4. Demonstrate whether ACEI in PAH pts on sildenafil has an effect on pulmonary gas exchange parameters (exhaled NO, Dm, Vc, DLCO). [ Time Frame: 32 weeks ]
5. Obtain exploratory data regarding whether ACEI in PAH pts on sildenafil improves functional class and 6 minute walk distance. [ Time Frame: 32 weeks ]

Eligibility Criteria

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Ages Eligible for Study:	18 Years to 75 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No
Sampling Method:	Probability Sample

Study Population

Participants will be currently diagnosed with Pulmonary Arterial Hypertension (PAH). Lisinopril versus placebo will be added to participants already recieving a stable dose of Sildenafil.

Criteria

Inclusion Criteria:

• Age 18-75
• World Health Organization (WHO) Group I PAH with prior documentation of peripheral vascular resistance (PVR) > 3 WU and wedge(PCW) 16 or less.
• WHO Functional Class I-III
• 6 minute walk distance 150-575 meters
• Women of child bearing potential must have a negative pregnancy test and be using effective contraception
• Receiving therapy with phosphodiesterase-5 inhibitor for PAH (sildenafil or tadalafil) for at least 3 months and with stable dose for at least 30 days
• If already receiving therapy with endothelin receptor antagonists must have been on therapy for at least 3 months and on stable dose for at least 30 days

Exclusion Criteria:

• Allergy or intolerance to captopril or other angiotensin converting enzyme inhibitors
• Systemic systolic blood pressure less than 100 mm Hg
• Therapy with prostanoids (iloprost, treprostinil, epoprostenol) within preceding 3 months
• Pregnant or breast feeding
• Creatinine > 2.0 mg/dl
• Potassium > 5.0 meq/dl
• Unable to provide informed consent
• TLC or VC <60% predicted
• Untreated obstructive sleep apnea
• LVEF < 40%
• Hb < 10 mg/dL

Contacts and Locations

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Locations

United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55905

Sponsors and Collaborators

Mayo Clinic

Investigators

Principal Investigator:	Robert P Frantz, MD	Mayo Clinic

More Information

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Responsible Party:	Robert P. Frantz, MD, Mayo Clinic
ClinicalTrials.gov Identifier:	NCT01181284 History of Changes
Other Study ID Numbers:	08-001716; MELISSA
First Posted:	August 13, 2010
Last Update Posted:	February 7, 2012
Last Verified:	February 2012

Keywords provided by Robert P. Frantz, Mayo Clinic:

Pulmonary Arterial Hypertension (PAH)

Additional relevant MeSH terms:

Hypertension; Familial Primary Pulmonary Hypertension; Vascular Diseases; Cardiovascular Diseases; Hypertension, Pulmonary; Lung Diseases; Respiratory Tract Diseases; Sildenafil Citrate; Lisinopril; Vasodilator Agents; Phosphodiesterase 5 Inhibitors	Phosphodiesterase Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action; Urological Agents; Angiotensin-Converting Enzyme Inhibitors; Protease Inhibitors; Antihypertensive Agents; Cardiotonic Agents; Protective Agents; Physiological Effects of Drugs