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HIGH Altitude CArdiovascular REsearch in the ANDES (HIGHCARE-A)

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT01830530
First Posted: April 12, 2013
Last Update Posted: April 12, 2013
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Collaborator:
Bayer
Information provided by (Responsible Party):
Istituto Auxologico Italiano
  Purpose
This study is aimed to assess the efficacy of combined treatment with two antihypertensive agents (telmisartan and nifedipine) in subjects with mild hypertension exposed to high altitude.

Condition Intervention Phase
Hypertension High Altitude Drug: Telmisartan Drug: Nifedipine Drug: placebo Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: HIGH Altitude CArdiovascular REsearch in the ANDES

Resource links provided by NLM:


Further study details as provided by Istituto Auxologico Italiano:

Primary Outcome Measures:
  • Effect of study treatment on 24 h ambulatory systolic blood pressure at high altitude [ Time Frame: After 6 weeks of study treatment, during high altitude visit ]
    Difference in 24 h ambulatory systolic BP at high altitude (Visit 4) between combination therapy group and placebo group


Secondary Outcome Measures:
  • Effect of study treatment on ambulatory blood pressure at high altitude (other variables) [ Time Frame: After 6 weeks of study treatment, during high altitude visit ]
    Differences in other ambulatory blood pressure (BP) variables (including 24 h diastolic BP, daytime and night-time BP, nocturnal fall of BP) at high altitude (V4) between combination therapy and placebo groups

  • Lake Louise Score [ Time Frame: After 6 weeks of study treatment, during high altitude visit ]
    Differences in Lake Louise Score (score of acute mountain sickness severity) between groups

  • Effect of high altitude on ambulatory blood pressure [ Time Frame: After 6 weeks of study treatment, during high altitude visit ]
    Change in ambulatory blood pressure between sea level condition and high altitude in both treatment groups

  • Effect of high altitude on conventional blood pressure [ Time Frame: After 6 weeks of study treatment, during high altitude visit ]
    Change in conventional blood pressure between sea level condition and high altitude in both groups

  • Effect of study treatment on conventional blood pressure at high altitude. [ Time Frame: After 6 weeks of study treatment, during high altitude visit ]
    Difference in conventional systolic and diastolic blood pressure at high altitude (Visit 4) between combination therapy group and placebo group

  • Rate of adverse events [ Time Frame: After 6 weeks of treatment plus up to 1 additional week of treatment needed for high altitude visit (study end). ]
    Differences in rate of adverse events between groups.

  • Effect of study treatment on ambulatory heart rate at high altitude [ Time Frame: After 6 weeks of study treatment, during high altitude visit ]
    Differences in ambulatory heart rate (HR) variables (including 24 h, daytime and night-time HR, and nocturnal fall of HR) at high altitude (V4) between combination therapy and placebo groups


Other Outcome Measures:
  • Differences in other variables assessed in the study at high altitude between treatment groups [ Time Frame: high altitude visit ( Visit 4) ]
    Differences between treatment groups in polysomnographic data, arterial stiffness, blood tests, echocardiography data assessed at high altitude

  • blood pressure response at sea level [ Time Frame: Sea level visit (3) and high altitude visit (4) ]
    Changes in polysomnographic data, arterial stiffness, blood tests, echocardiography data between sea level condition and high altitude


Enrollment: 100
Study Start Date: May 2012
Study Completion Date: October 2012
Primary Completion Date: September 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Telmisartan/nifedipine
Subjects treated with telmisartan 80 mg (1 capsule daily in the morning) plus nifedipine slow release 30 mg (1 capsule daily in the morning) combination
Drug: Telmisartan
Subjects treated with telmisartan 80 mg (1 capsule daily in the morning) plus nifedipine slow release 30 mg (1 capsule daily in the morning) combination
Other Names:
  • Pritor
  • Micardis
Drug: Nifedipine
Subjects treated with telmisartan 80 mg (1 capsule daily in the morning) plus nifedipine slow release 30 mg (1 capsule daily in the morning) combination
Other Name: Adalat
Placebo Comparator: Placebo
Two tablets containing placebo daily in the morning
Drug: placebo
two tablets daily in the morning

Detailed Description:

This is a parallel group, prospective, double-blind, placebo controlled randomized trial, comparing the effects of combination of two antihypertensive agents (telmisartan/nifedipine)with placebo in hypertensive subjects exposed to high altitude. The principal objectives are:

  1. to assess the response of BP to high altitude exposure in hypertensive subjects residing at sea level
  2. To assess the efficacy and safety of combination of telmisartan 80 mg with nifedipine GITS 30 mg in preventing a possible excessive BP increase in hypertensive subjects exposed to high altitude.

The following data will be collected during the study at the different steps:

  • Clinical history
  • Symptoms and adverse events questionnaire
  • Conventional BP and heart rate (HR) measurement - seated measurements with a validated oscillometric device will be performed after at least 5 minutes rest on non-dominant arm; two measurements will be performed 1-2 minutes apart and their average will be used in the analyses
  • Vital signs:

respiratory rate - will be measured manually over 60 seconds body height and weight, waist circumference blood oxygen saturation (SpO2)

  • Lake Louise Score
  • 24 h ambulatory blood pressure monitoring (ABPM; AND TM2430, AND, Japan)
  • Echocardiography
  • Arterial properties assessment
  • Six minute walking test (6MWT)
  • Cardiopulmonary Exercise Test (CPET) in a subgroup of subjects
  • Polysomnography with a portable device
  • Pulmonary function tests (only at sea level baseline visit)
  • Fluid balance chart
  • Blood and urine analyses: Visit 1: electrolytes, creatinine, estimated glomerular filtration rate (eGFR), glycemia, renin, angiotensin, aldosterone, plasma catecholamines, 24 h urinary sodium excretion, carbonic anhydrase activity and isoenzyme expression (in 50 randomly selected subjects), samples for genetic studies. Visit 2: electrolytes, creatinine, eGFR. Visit 3: complete blood count, electrolytes, creatinine, eGFR, glycemia, insulin, renin, angiotensin, aldosterone, plasma catecholamines, classic urinalysis, microalbuminuria, 24 h urinary sodium excretion, carbonic anhydrase activity and isoenzyme expression (in 50 subjects selected at Visit 1). Visit 4: electrolytes, creatinine, eGFR, glycemia, insulin, renin, angiotensin, aldosterone, plasma catecholamines, 24 h urinary sodium excretion, carbonic anhydrase activity and isoenzyme expression (in 50 subjects selected at Visit 1)
  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Permanent residence at low (<500 m) altitude
  • Conventional systolic BP (average of two measurements) 140-159 mmHg or conventional diastolic BP 90-99 mmHg in subjects untreated or after 4 weeks of washout
  • Mean daytime systolic BP ≥135 and <150 mmHg and/or mean daytime diastolic BP ≥85 and <95 mmHg in subjects untreated or after 4 weeks of washout
  • Written informed consent to participate in the study

Exclusion Criteria:

  • Conventional systolic BP (average of two measurements) ≥150 mmHg and conventional diastolic BP ≥95 mmHg in treated subjects
  • Regular use of two or more antihypertensive drugs (with the exception of subjects on two antihypertensive drugs in low doses)
  • Treated antihypertensive subjects in whom withdrawal of treatment is deemed unethical by the investigator (e.g. because of the existence of compelling indications other than hypertension for continuous use of previously used antihypertensive agent)
  • Contraindications (including a history of adverse reactions) to angiotensin receptor blockers or calcium antagonists
  • History of serious mountain sickness
  • Subjects who over 3 months preceding inclusion in the study spent considerable (> 1 week) amount of time at altitudes above 2500 m.
  • Cardiovascular diseases other than hypertension (coronary heart disease, heart failure, atrial fibrillation, valvular or congenital heart disease, cardiomyopathies, cerebrovascular disease, peripheral artery disease, aortic aneurysm)
  • Suspected or confirmed secondary hypertension
  • Diabetes mellitus
  • Serious respiratory disorders
  • Other conditions deemed relevant by the investigator (including liver disease, renal disease, thyroid disorders)
  • BMI ≥35 kg/m2
  • Upper arm circumference >32 cm
  • known severe obstructive sleep apnea (apnea-hypopnea index > 30 or use of CPAP) or excessive daytime sleepiness (Epworth Sleepiness Scale > 10)
  • Pregnancy
  • Premenopausal women not using effective contraceptive methods
  • Elevated probability of noncompliance with the study procedures
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01830530


Locations
Peru
Universidad Peruana Cayetano Heredia
Lima, Peru
Sponsors and Collaborators
Istituto Auxologico Italiano
Bayer
Investigators
Principal Investigator: Gianfranco Parati, MD, PhD Istituto Auxologico Italiano
  More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Istituto Auxologico Italiano
ClinicalTrials.gov Identifier: NCT01830530     History of Changes
Other Study ID Numbers: 09F102
First Submitted: February 18, 2013
First Posted: April 12, 2013
Last Update Posted: April 12, 2013
Last Verified: February 2013

Keywords provided by Istituto Auxologico Italiano:
arterial hypertension
high altitude
hypobaric hypoxia
combination treatment
angiotensin receptor blocker
calcium antagonist

Additional relevant MeSH terms:
Hypertension
Altitude Sickness
Vascular Diseases
Cardiovascular Diseases
Respiration Disorders
Respiratory Tract Diseases
Telmisartan
Nifedipine
Antihypertensive Agents
Angiotensin II Type 1 Receptor Blockers
Angiotensin Receptor Antagonists
Molecular Mechanisms of Pharmacological Action
Calcium Channel Blockers
Membrane Transport Modulators
Vasodilator Agents
Tocolytic Agents
Reproductive Control Agents
Physiological Effects of Drugs