Clinical trial NCT00240656: Spironolactone Combined With Captopril and Carvedilol for the Treatment of Pulmonary Arterial Hypertension
Official title: 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
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
Conditions: Hypertension, Pulmonary
Keywords: aldosterone antagonists, spironolactone, captopril carvedilol
Lead sponsor: Hebei Medical University
Sponsor class: OTHER
First posted: 2005-10-18
Sex: ALL
Maximum age (years): 80
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: 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

Detailed description: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Dyspnoea score
measure: Exercise capacity (six-minute walk)
measure: NYHA/WHO functional class
measure: Change of acropachy
measure: Blood gas test
measure: Pulmonary artery pressure (measured by echocardiogram or catheter)
Secondary outcomes:
measure: Other echocardiographic changes:
measure: Systolic pulmonary arterial pressure
measure: Change of right to left shunt expressed by time-velocity integral (TVI) from the defect
measure: Change of left to right shunt expressed by TVI from the defect
measure: Right ventricular (RV) acceleration time (ms)
measure: RV ejection time (ms)
measure: Ratio of RV ejection time/RV acceleration time
measure: Pulmonary arterial valve TVI
measure: Change of diameters of both left and right ventricles
measure: Change of diameters of both left and right atrium
measure: Doppler mitral valve (MV) TVI
measure: Blood gas test
Other outcomes:
Locations:
city: Shijiazhuang
country: China
facility: The First Hospital of Hebei Medical University
state: Hebei
Study officials:
affiliation: The First Hospital of Hebei Medical University
name: Kunshen Liu, M.D.
role: STUDY_CHAIR
References: