Clinical Trial: Contribution of Angiotensin II to Supine Hypertension in Autonomic Failure
Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional
Official Title: Contribution of Angiotensin II to Supine Hypertension in Autonomic Failure
Brief Summary: The purpose of this study is to test the hypothesis that angiotensin II plays a role in the supine hypertension of primary autonomic failure. To determine the contribution of angiotensin II to renin and blood pressure regulation in autonomic failure, patients with multiple system atrophy [MSA] or pure autonomic failure [PAF] and supine hypertension will undergo medication testing with the angiotensin II receptor blocker losartan. The investigators will compare the biochemical and hemodynamic effects between MSA and PAF patients. In a subset of patients, the investigators will also give the ACE inhibitor captopril. Our primary endpoint will be changes in plasma renin activity, and subsequent components of the circulating renin-angiotensin system, in response to angiotensin II blockade. Our secondary outcome will be changes in hemodynamic measures during administration of these drugs.
Detailed Summary:
Primary autonomic failure is a disabling condition characterized by orthostatic hypotension. It is less well appreciated that at least 50% of these patients have high blood pressure when lying down [supine hypertension]. The mechanisms underlying supine hypertension in autonomic failure remain poorly understood. The hypertension in MSA patients may be explained by residual sympathetic tone, possibly acting on hypersensitive adrenoreceptors and unrestrained by the lack of baroreflex modulation. In contrast, the hypertension in PAF is associated with increased vascular resistance in the absence of residual sympathetic tone. However, the factors driving an elevation in either sympathetic or vascular tone in these patients remain unclear.
The investigators hypothesize that angiotensin II, a hormone widely implicated in blood pressure regulation, plays a role in the supine hypertension of autonomic failure. To determine the contribution of angiotensin II to renin and blood pressure regulation in autonomic failure, the investigators will administer the angiotensin II receptor blocker losartan to MSA and PAF patients with supine hypertension. The primary endpoint will be changes in plasma renin activity, and subsequent components of the circulating renin-angiotensin system, in response to angiotensin II blockade. The secondary outcomes will be the decrease in blood pressure and changes in heart rate, cardiac output, stroke volume and systemic vascular resistance during administration of these drugs.
Subjects will be studied on 2 separate days, one with oral administration of placebo and the other with losartan [50 mg]. The order of administration will be randomized in a single-blind manner. The investigators will collect blood samples before and every 2 hours after administration for up to 6 hours to determine if angiotensin II r
Sponsor: Vanderbilt University
Current Primary Outcome: Changes in plasma renin activity and subsequent components of the circulating renin-angiotensin system [ Time Frame: 0 - 6 hours post administration ]
Original Primary Outcome: Change in systolic blood pressure [ Time Frame: 0 - 6 hours post administration ]
Current Secondary Outcome:
- Changes in blood pressure [ Time Frame: 0 - 6 hours post administration ]
- Changes in heart rate, cardiac output, stroke volume and systemic vascular resistance [ Time Frame: 0 - 6 hours post administration ]
Original Secondary Outcome:
- Changes in heart rate, cardiac output, stroke volume and systemic vascular resistance [ Time Frame: 0 - 6 hours post administration ]
- Changes in plasma renin activity, or other components of the circulating renin-angiotensin system [ Time Frame: 0 - 6 hours post administration ]
Information By: Vanderbilt University Medical Center
Dates:
Date Received: February 8, 2011
Date Started: April 2011
Date Completion: December 2017
Last Updated: January 13, 2017
Last Verified: January 2017
