The Antihypertensives and Vascular, Endothelial and Cognitive Function Trial - Full Text View

Sponsor:	Hebrew Rehabilitation Center, Boston
Collaborators:	National Institute on Aging (NIA) Hebrew SeniorLife
Information provided by:	Hebrew Rehabilitation Center, Boston
ClinicalTrials.gov Identifier:	NCT00605072

Purpose

The purpose of this study is to examine the effects of blood pressure medications on cognition and blood flow in hypertensive elderly patients with cognitive impairment. The hypothesis is that treatment with an angiotensin receptor blocker (ARB) or an angiotensin-converting enzyme inhibitor (ACEI) will be associated with a slower rate of further cognitive decline, improved cerebral blood flow and its regulation, and preserved physical function as compared to treatment with a diuretic (HCTZ), independent of blood pressure level.

Condition	Intervention	Phase
Impaired Cognition Hypertension Aging	Drug: candesartan Drug: lisinopril Drug: hydrochlorothiazide Drug: nifedipine, long acting Drug: metoprolol, long-acting	Phase II

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment
Official Title:	The Antihypertensives and Vascular, Endothelial and Cognitive Function Trial (AVEC Trial)

Resource links provided by NLM:

MedlinePlus related topics: Blood Pressure Medicines High Blood Pressure

Drug Information available for: Hydrochlorothiazide Nifedipine Metoprolol Metoprolol Tartrate Lisinopril Metoprolol succinate Metoprolol fumarate CV 11974 Candesartan cilexetil

U.S. FDA Resources

Further study details as provided by Hebrew Rehabilitation Center, Boston:

Primary Outcome Measures:

Cognitive assessment measured by Trail Making Test, Hopkins Verbal Learning Test - Revised (HVLT-R), and Digit Span Test [ Time Frame: Baseline, 1, 6, and 12 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Changes in Cerebral Blood Flow (CBF) and cerebral vasoreactivity [ Time Frame: Baseline, then 6 and 12 months after BP control ] [ Designated as safety issue: No ]
Endothelial function assessed using the flow mediated dilatation (FMD) procedure [ Time Frame: Baseline, then 6 and 12 months after BP control ] [ Designated as safety issue: No ]
Biochemical measurement to monitor for adverse events: hyperkalemia, renal failure, leukopenia and liver function abnormalities [ Time Frame: Baseline, 2-4 weeks, 2, 4, 9, and 12 months ] [ Designated as safety issue: Yes ]

Estimated Enrollment:	100
Study Start Date:	January 2008
Estimated Study Completion Date:	December 2011
Estimated Primary Completion Date:	December 2011 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: ARB Angiotensin Receptor Blocker	Drug: candesartan orally 8 mg increased to 16 mg then 32 mg to achieve target blood pressure of 140/90, then daily for 12 months Other Name: Atacand Drug: nifedipine, long acting If needed to achieve target blood pressure of 140/90, added to ARB or ACEI at 30 mg increased to 60 mg and 90 mg in 2 week increments Other Name: Procardia XL Drug: metoprolol, long-acting If needed to achieve target blood pressure of 140/90, added to ARB or ACEI at 12.5 mg increased to 25 mg and 50 mg Other Name: Lopressor, Toprol XL
Experimental: ACEI Angiotensin-Converting Enzyme (ACE) Inhibitor	Drug: lisinopril orally 10 mg increased to 20 mg then 40 mg to achieve target blood pressure of 140/90, then daily for 12 months Other Name: Prinivil Drug: nifedipine, long acting If needed to achieve target blood pressure of 140/90, added to ARB or ACEI at 30 mg increased to 60 mg and 90 mg in 2 week increments Other Name: Procardia XL Drug: metoprolol, long-acting If needed to achieve target blood pressure of 140/90, added to ARB or ACEI at 12.5 mg increased to 25 mg and 50 mg Other Name: Lopressor, Toprol XL
Active Comparator: HCTZ	Drug: hydrochlorothiazide orally 12.5 mg increased to 25 mg to achieve target blood pressure of 140/90, then daily for 12 months Other Name: HCTZ, multiple brand names

Detailed Description:

There is mounting evidence that hypertension, which affects more than 65% of the US elderly population, accelerates cognitive decline and increases the risk of functional disability among older individuals. Hypertension is also associated with cerebral blood flow reduction and dysregulation which contribute to further cognitive and functional impairment. Drugs that inhibit angiotensin II (ACEI and ARB) are commonly used antihypertensives and may have a protective effect on cognitive function, cerebral blood flow and physical function compared to other antihypertensives such as hydrochlorothiazide (HCTZ).

A total of 100 individuals will be recruited for this pilot 3-arm randomized study to investigate the effects of: (i) 12 months treatment with candesartan (ARB) compared to hydrochlorothiazide (HCTZ) and (ii) 12 months treatment with lisinopril (ACEI) compared to HCTZ and (iii) to estimate the effect size difference between lisinopril and losartan on cognition, cerebral blood flow regulation, and functional measures in a sample of elderly hypertensive individuals with objective evidence of cognitive impairment.

Eligibility

Ages Eligible for Study:	60 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

60 years or older
Hypertension
Cognitive criteria: score either 10 or less out of 15 for the executive clock draw test 1 (CLOX1) or less than or equal to 1 standard deviation from the corresponding age specific mean on the immediate memory subtest

Exclusion Criteria:

Intolerance to ACEI or ARB
History of congestive heart failure
History of diabetes mellitus
History of stroke (less than 6 months)

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00605072

Locations

United States, Massachusetts
Institute for Aging Research at Hebrew SeniorLife
Boston, Massachusetts, United States, 02131

Sponsors and Collaborators

Hebrew Rehabilitation Center, Boston

National Institute on Aging (NIA)

Hebrew SeniorLife

Investigators

Principal Investigator:

Ihab Hajjar, MD

Hebrew SeniorLife

More Information

Publications:

Lipsitz LA, Gagnon M, Vyas M, Iloputaife I, Kiely DK, Sorond F, Serrador J, Cheng DM, Babikian V, Cupples LA. Antihypertensive therapy increases cerebral blood flow and carotid distensibility in hypertensive elderly subjects. Hypertension. 2005 Feb;45(2):216-21. Epub 2005 Jan 17.

Waldstein SR, Katzel LI. Gender differences in the relation of hypertension to cognitive function in older adults. Neurol Res. 2004 Jul;26(5):502-6.

Pugh KG, Kiely DK, Milberg WP, Lipsitz LA. Selective impairment of frontal-executive cognitive function in african americans with cardiovascular risk factors. J Am Geriatr Soc. 2003 Oct;51(10):1439-44.

Kuo HK, Sorond F, Iloputaife I, Gagnon M, Milberg W, Lipsitz LA. Effect of blood pressure on cognitive functions in elderly persons. J Gerontol A Biol Sci Med Sci. 2004 Nov;59(11):1191-4.

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Hajjar I, Hart M, Milberg W, Novak V, Lipsitz L. The rationale and design of the antihypertensives and vascular, endothelial, and cognitive function (AVEC) trial in elderly hypertensives with early cognitive impairment: Role of the renin angiotensin system inhibition. BMC Geriatr. 2009 Nov 18;9:48.

Responsible Party:	Ihab Hajjar, MD, Hebrew SeniorLife
ClinicalTrials.gov Identifier:	NCT00605072 History of Changes
Other Study ID Numbers:	IA0127, K23AG030057, 1K23AG30057-01A1
Study First Received:	January 11, 2008
Last Updated:	March 17, 2011
Health Authority:	United States: Federal Government

Keywords provided by Hebrew Rehabilitation Center, Boston:

cognitive disorders

Additional relevant MeSH terms:

Hypertension
Cognition Disorders
Vascular Diseases
Cardiovascular Diseases
Delirium, Dementia, Amnestic, Cognitive Disorders
Mental Disorders
Angiotensin-Converting Enzyme Inhibitors
Lisinopril
Candesartan
Candesartan cilexetil
Antihypertensive Agents
Metoprolol
Hydrochlorothiazide
Nifedipine
Angiotensin Receptor Antagonists

Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Cardiovascular Agents
Therapeutic Uses
Anti-Arrhythmia Agents
Sympatholytics
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Adrenergic beta-1 Receptor Antagonists
Adrenergic beta-Antagonists
Adrenergic Antagonists
Adrenergic Agents

ClinicalTrials.gov processed this record on February 12, 2012