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The Effect of Nebivolol in Hypertensive Patients With Coronary Arterial Spasm

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.
 
ClinicalTrials.gov Identifier: NCT03930433
Recruitment Status : Completed
First Posted : April 29, 2019
Last Update Posted : March 10, 2020
Sponsor:
Collaborators:
Korea University Guro Hospital
Korea Unversity Ansan Hospital
Severance Hospital
Information provided by (Responsible Party):
Soon Jun Hong, Korea University Anam Hospital

Brief Summary:
The correlation between endothelial dysfunction and the risk of coronary heart disease is well known through previous studies. The degradation of the function of nitric oxide acting on the endothelium of blood vessels is mainly explained by reduction of synthesis, loss due to oxidative stress, and decreased sensitivity to vascular dilatation action. In particular, patients with high blood pressure have been known to have impaired vascular endothelial function through animal experiments and several clinical studies, mainly due to increased biomechanical friction in the blood vessels and decreased biological availability of nitric oxide, which in turn causes incongruity in the production of nitric monoxide and changes in normal vascular dilatation. There have also been reports recently that early diagnosis and treatment may improve endothelial dysfunction and prevent the progression of coronary artery disease. However, the reality is that the drugs available in vasospastic angina patients with endothelial dysfunction are very limited. Until recently, beta-blockers were reported to inhibit vascular dilatation of adrenaline stimuli, a drug corresponding to relative contraindications in vasospastic angina patients, with one study reporting that propranolol cannot, but rather exacerbates, vasospastic angina. However, a series of reports on the vascular dilatation of the recently developed third-generation beta-blockers have reinvented the role of beta-blockers in vasospastic angina, especially nebivolol (selective, continuous beta-blockers) is known to act on β-1 adrenaline receptor blockings and endothelium to create vascular dilatation, and also to stimulate β-3 adrenaline receptors to cause nitric oxide generation and antioxidant effects in the endothelium of blood vessels. Therefore, this clinical trial seeks to find whether nebivolol will inhibit vascular contraction in hypertensive patients and will work in angiospastic angina patients.

Condition or disease Intervention/treatment Phase
Coronary Vasospasm Drug: Nebivolol Drug: Diltiazem Drug: Nebivolol+Diltiazem Phase 4

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 51 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Group 1: Nebivolol group Group 2: Diltiazem group Group 2: Nebivolol + Diltiazem group
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: The Effect of Nebivolol in Hypertensive Patients With Coronary Arterial Spasm
Actual Study Start Date : January 1, 2018
Actual Primary Completion Date : March 31, 2019
Actual Study Completion Date : March 31, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Muscle Cramps

Arm Intervention/treatment
Active Comparator: Nebivolol group
Oral Nebivolol 5mg / day (2 weeks) -> 10mg / day (10 weeks)
Drug: Nebivolol
Patients are randomly assigned to a ratio of 1: 1: 1, divided into 3 groups.

Placebo Comparator: Diltiazem group
Oral Diltiazem 90mg / day (2 weeks) -> 180mg / day (10 weeks)
Drug: Diltiazem
Patients are randomly assigned to a ratio of 1: 1: 1, divided into 3 groups.

Placebo Comparator: Nebivolol+Diltiazem group
Oral Nebivolol 2.5mg / day + Oral Diltiazem 45mg / day (2 weeks) -> Oral Nebivolol 5mg / day + Oral Diltiazem 90mg / day (10 weeks)
Drug: Nebivolol+Diltiazem
Patients are randomly assigned to a ratio of 1: 1: 1, divided into 3 groups.




Primary Outcome Measures :
  1. Changes in coronary spasm [ Time Frame: Baseline to 12 weeks ]
    The descriptive statistics (mean subject number, standard deviation, median value, minimum value, and maximum value) of changes in the baseline and 12-week outcomes will be presented for each treatment group, and the comparison between the three groups for ANOVA or ANOVA Kruskal-Wallis test. Changes in each group will be analyzed using Paired t-test or Wilcoxon signed rank test. An ANCOVA analysis will be performed when there are more influencing factors.


Secondary Outcome Measures :
  1. Changes in Quality of Life [ Time Frame: Baseline to 12 weeks ]
    Changes in Quality of Life based on Seattle Angina Questionnaire

  2. Changes in mean sitting systolic blood pressure and mean sitting diastolic blood pressure [ Time Frame: Baseline to 6, 12 weeks ]
    Changes in mean sitting systolic blood pressure and mean sitting diastolic blood pressure

  3. Percentage of target blood pressure reached [ Time Frame: Baseline to 6, 12 weeks ]
    Percentage of target blood pressure reached from baseline to 6, 12 weeks



Information from the National Library of Medicine

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Ages Eligible for Study:   20 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • hypertension (stage I-2: Systolic blood pressure 140-179mmHg and diastolic blood pressure 90-109mmHg)
  • 20 to 80 years old
  • diagnosed with vasospastic angina through coronary angiography and provocation test
  • available to outpatient treatment
  • voluntarily signed a written consent to participate in the clinical trial

Exclusion Criteria:

  1. Previous history of hypersensitivity to beta blockers or calcium channel blockers
  2. History of dementia or accompanying psychiatric illness or history of drug abuse
  3. Those who participated in other clinical trials within 1 month before screening
  4. A person who is unable to perform compliance with the plan and procedures, or who has been judged by the tester to be in a medical condition inappropriate for participation
  5. Study subjects who are taking drugs that can affect the study drug efficacy evaluation (ACE inhibitors, angiotensin blockers, beta blockers other than clinical trial drugs, calcium antagonists other than clinical trial drugs, diuretics other than indapamide). These subjects are allowed to participate after a wash-out period of at least 2 weeks
  6. Malignant hypertension (with retinal hemorrhage or papilledema) or known moderate or severe retinopathy (retinal hemorrhage within the last 6 months, visual disturbance, retinal microaneurysm)
  7. A history of secondary hypertension and all suspected secondary hypertension: coarctation of the aorta, hyperaldosteronism, renal artery stenosis, Cushing's disease, chromatin-positive cell tumor, polycystic kidney disease, etc.
  8. Patients with orthostatic hypotension with symptoms
  9. Patients with severe heart disease (heart failure New York Heart Association class 3 and 4), recent 6-month ischemic heart disease (angina pectoris, myocardial infarction), percutaneous coronary intervention, or coronary artery bypass surgery)
  10. Patients with severe cerebrovascular disease (stroke, cerebral infarction, cerebral hemorrhage within the last 6 months)
  11. Patients with anuria or severe renal failure (creatinine clearance <30 mL / min)
  12. Severe liver failure or AST or ALT> 3 times the upper limit of normal, biliary obstruction, biliary cirrhosis, cholestasis
  13. Gastrointestinal diseases and surgery patients that may affect the absorption, distribution, metabolism, and excretion of drugs, current active gastritis and gastrointestinal / rectal bleeding that the tester considers clinically significant, active inflammatory bowel syndrome within the last 12 months
  14. Pregnant and lactating women, those who have a pregnancy plan during the trial and do not agree with the appropriate method of contraception

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): NCT03930433


Locations
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Korea, Republic of
Korea University Anam Hospital
Seoul, Korea, Republic of, 02841
Sponsors and Collaborators
Korea University Anam Hospital
Korea University Guro Hospital
Korea Unversity Ansan Hospital
Severance Hospital
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Responsible Party: Soon Jun Hong, Professor, Korea University Anam Hospital
ClinicalTrials.gov Identifier: NCT03930433    
Other Study ID Numbers: NevibololSpasm
First Posted: April 29, 2019    Key Record Dates
Last Update Posted: March 10, 2020
Last Verified: March 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Soon Jun Hong, Korea University Anam Hospital:
Nebivolol
Additional relevant MeSH terms:
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Coronary Vasospasm
Coronary Disease
Myocardial Ischemia
Heart Diseases
Cardiovascular Diseases
Vascular Diseases
Nebivolol
Diltiazem
Antihypertensive Agents
Vasodilator Agents
Adrenergic beta-1 Receptor Agonists
Adrenergic beta-Agonists
Adrenergic Agonists
Adrenergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Calcium Channel Blockers
Membrane Transport Modulators
Calcium-Regulating Hormones and Agents