Clinical trial NCT01684748: Angiotensin II Blockade and Inflammation in Obesity
Official title: Angiotensin II Blockade and Adipose Tissue Inflammation in Obesity
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Overweight
Obese
Prehypertension
Hypertension
Keywords: angiotensin II
obesity
diabetes
Lead sponsor: Virginia Polytechnic Institute and State University
Sponsor class: OTHER
Collaborators: name: National Heart, Lung, and Blood Institute (NHLBI)
First posted: 2012-09-13
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: PREVENTION

Brief summary: Overweight and obesity, which afflicts \~65% of the U.S. population and more than 1 billion people worldwide, increases the risk of developing hypertension. Activation of the renin angiotensin system (RAS) is an important mechanism by which obesity leads to hypertension. In addition to its vasoconstricting and sodium retaining actions, angiotensin II also has potent pro-inflammatory actions including macrophage infiltration and expression of proinflammatory cytokines in target tissues. Adipose tissue and skeletal muscle appear to be a key sites for the generation of proinflammatory cytokines. Although angiotensin II receptor blockade reduces inflammation in many tissues, the effects on adipose tissue and skeletal muscle in humans are not clear. Importantly, the chronic low grade inflammatory state that accompanies obesity complicates hypertension by contributing to insulin resistance and accelerating cardiovascular disease. Therefore, the general aim of the present proposal will be to determine the influence of angiotensin II receptor blockade on adipose tissue and skeletal muscle inflammation and its relation to improvements in insulin sensitivity, if observed, in obese hypertensive humans. To address these aims, 44 obese (BMI\>30 kg/m2) hypertensive (BP\>140 systolic and/or 90 diastolic) individuals (age=50-65 years) will be randomized to receive 8 weeks of either the angiotensin II receptor antagonist, olmesartan medoxomil, or no treatment in a crossover manner. Subcutaneous adipose tissue and skeletal muscle biopsies will be obtained and insulin sensitivity (intravenous glucose tolerance tests) will be assessed at baseline and following 8 weeks of each intervention. A two week washout period will separate the interventions.


Eligibility criteria: Inclusion Criteria:

* 18-75 years of age
* Weight stable for previous 6 months (+2.0kg)
* Sedentary to recreationally active
* Willing to be randomized to treatment or placebo
* Verbal and written informed consent
* Approved for participation by Medical Director (Jose Rivero, M.D.)

Exclusion Criteria:

* Blood pressure outside stated range
* Diabetes or taking diabetes medications
* Total cholesterol \>6.2 mmol/L; triglycerides \>4.5 mmol/L
* Past or current ischemic heart disease, stroke, respiratory disease, endocrine or metabolic disease, neurological disease, or hematological-oncological disease
* Evidence of renal insufficiency; GFR\< 60 ml/min\*
* Medications (including but not limited to antihypertensives, statins or other with anti-inflammatory actions) or antioxidant vitamins or supplements
* Known allergy or hypersensitivity to olmesartan or any of its components
* Pregnant or planning to become pregnant

Primary outcomes:
measure: Insulin Sensitivity by Intravenous Glucose Tolerance Testing (Change Over Time)
timeFrame: Baseline testing to post-testing after 8-week intervention
Secondary outcomes:
Other outcomes:
measure: Collagen Gene Expression in Skeletal Muscle (Change Over Time)
timeFrame: Baseline testing to post-testing after 8-week intervention
Locations:
Study officials:
affiliation: Virginia Polytechnic Institute and State University
name: Kevin P. Davy, Ph.D.
role: PRINCIPAL_INVESTIGATOR
References: