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Diurnal Variation of Plasminogen Activator Inhibitor-1

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ClinicalTrials.gov Identifier: NCT00515021
Recruitment Status : Completed
First Posted : August 13, 2007
Results First Posted : February 1, 2019
Last Update Posted : February 1, 2019
Sponsor:
Collaborator:
National Center for Research Resources (NCRR)
Information provided by (Responsible Party):
James Muldowney, Vanderbilt University Medical Center

Tracking Information
First Submitted Date  ICMJE August 9, 2007
First Posted Date  ICMJE August 13, 2007
Results First Submitted Date  ICMJE March 16, 2017
Results First Posted Date  ICMJE February 1, 2019
Last Update Posted Date February 1, 2019
Study Start Date  ICMJE April 2007
Actual Primary Completion Date April 2010   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: January 31, 2019)
  • Plasminogen Activator Inhibitor-1 (PAI-1) Levels [ Time Frame: Baseline ]
    baseline PAI-1 levels prior to drug administration
  • Plasminogen Activator Inhibitor-1 (PAI-1) Levels [ Time Frame: after 6 weeks on Eplerenone ]
    PAI-1 levels after Eplerenone 50mg daily for 2 weeks then 100mg daily for 4 weeks. Time of administration varied in the arms, either morning or night time dosing.
Original Primary Outcome Measures  ICMJE
 (submitted: August 10, 2007)
Evidence of improved fibrinolytic balance [ Time Frame: 14 weeks ]
Change History Complete list of historical versions of study NCT00515021 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures  ICMJE Not Provided
Original Secondary Outcome Measures  ICMJE Not Provided
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Diurnal Variation of Plasminogen Activator Inhibitor-1
Official Title  ICMJE The Effects of Night-time Versus Morning Administration of Eplerenone on the Diurnal Variation of Plasminogen Activator Inhibitor-1
Brief Summary To determine if nighttime administration of an aldosterone antagonist would effectively lower peak plasma Plasminogen Activator Inhibitor-1 (PAI-1) levels more effectively than morning administration.
Detailed Description

Plasminogen activator inhibitor-1, a member of the serine protease inhibitor (serpin) superfamily, is the principal inhibitor to tissue-type plasminogen activator and urokinase-type plasminogen activator. Elevated plasma PAI-1 levels, an independent cardiovascular risk factor, has been shown to be a predictor of recurrent myocardial infarction (MI). Acute changes in plasma PAI-1 after MI is a predictor of mortality. PAI-1 levels are elevated in the individuals with hypertension, insulin resistance, hypertriglyceridemia, obesity, and the constellation of risk-factors known as the metabolic syndrome. PAI-1 is synthesized in the liver, vascular endothelium, vascular smooth muscle, and visceral adipose tissue. A number of factors have been shown to regulate PAI-1, including metabolic factors such as insulin, glucose, triglycerides; inflammatory cytokines such as tumor necrosis factor-α, transforming growth factor-β, interleukin-1, and more notably, components of the renin-angiotensin-aldosterone system (RAAS), namely angiotensin II and aldosterone.

PAI-1 also has a diurnal variation with a peak plasma level occurring between 8 and 9 AM that may help explain why the incidence of acute MI is highest in the morning and why thrombolysis is least effective at that time. PAI-1's diurnal variation is been shown to be directly regulated by central and peripheral circadian pacemakers in vitro, and in vivo. Our group has observed that the diurnal variation of plasma PAI-1 levels is blunted and delayed in blind individuals who's circadian mechanisms are free running (not controlled by a central circadian pacemaker) when compared to those whose circadian rhythms are entrained (controlled by a central circadian pacemaker) (unpublished data), suggesting an additional system may modulate diurnal variation of PAI-1. As plasma renin activity (PRA) and aldosterone levels peak earlier than PAI-1 levels, they may be partially responsible. Indeed, continuous infusion of candesartan eliminated diurnal variation of aortic PAI-1 message expression in Wistar-Kyoto and spontaneously hypertensive rats, while hydralazine did not.

The use of therapies to modulate plasma PAI-1 levels in human subjects have met with variable success. Low salt diet was shown to increase plasma PAI-1 levels in normotensive subjects in a manner that correlated with plasma aldosterone levels. Twice daily treatment with quinapril (40mg) lowered plasma PAI-1 levels during the expected peak time. In a second study of twice daily quinapril compared to twice daily losartan in normotensive subjects both only had a modest effect on plasma PAI-1 levels. A third study helped to explain this finding. In a crossover study, hypertensive subjects received daily spironolactone or hydrochlorothiazide (HCTZ) in a randomized fashion. Plasma PAI-1 levels were increased after HCTZ treatment, but not significantly changed from baseline with spironolactone treatment. Spironolactone treatment, however, resulted in significantly higher aldosterone levels. The correlation between plasma aldosterone and PAI-1 that was observed at baseline and with HCTZ treatment was not observed in the spironolactone arm, suggesting that the endogenous relationship between aldosterone and PAI-1 can be disrupted by mineralocorticoid receptor antagonism.

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 4
Study Design  ICMJE Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Basic Science
Condition  ICMJE Metabolic Syndrome X
Intervention  ICMJE
  • Drug: Eplerenone (Morning)

    Eplerenone - 50mg, by mouth, daily, in the morning x 2 weeks followed by 4 weeks at 100mg.

    100mg, by mouth, daily, in the morning x 4 weeks then patients cross over to 100mg, by mouth, daily, in the evening x another 4 weeks.

    Other Name: Inspra
  • Drug: Eplerenone (Night-time)
    Eplerenone - 50mg, by mouth, daily in the evening x 2 weeks followed by 4 weeks at 100mg
    Other Name: Inspra
Study Arms  ICMJE
  • Experimental: Daytime then nightime dosing
    Eplerenone - 50mg, by mouth, daily, in the morning x 2 weeks followed by 100mg, by mouth, daily, in the morning x 4 weeks then patients cross over to 50mg, by mouth, daily, in the evening x 2 weeks followed by 100mg, by mouth, daily, in the evening x 4 weeks.
    Interventions:
    • Drug: Eplerenone (Morning)
    • Drug: Eplerenone (Night-time)
  • Experimental: Nighttime then daytime dosing
    Eplerenone - 50mg, by mouth, daily, in the evening x 2 weeks followed by 100mg, by mouth, daily, in the evening x 4 weeks then patients cross over to 50mg, by mouth, daily, in the morning x 2 weeks followed by 100mg, by mouth, daily, in the morning x 4 weeks.
    Interventions:
    • Drug: Eplerenone (Morning)
    • Drug: Eplerenone (Night-time)
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Completed
Actual Enrollment  ICMJE
 (submitted: January 31, 2019)
21
Original Estimated Enrollment  ICMJE
 (submitted: August 10, 2007)
40
Actual Study Completion Date  ICMJE April 2010
Actual Primary Completion Date April 2010   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Age18-65
  • Metabolic Syndrome (3 or more of the following):

    1. Blood pressure 130/85 or greater
    2. Central obesity (Waist - Male > 40", Female > 35")
    3. Fasting glucose ≥ 110 mg/dl
    4. Low HDL (Male < 40 mg/dl, Female < 50 mg/dl)
    5. Elevated Triglycerides (> 150 mg/dl)

Exclusion Criteria:

  • Cigarette Use
  • Renal insufficiency
  • Coronary Artery Disease
  • Diabetes
  • Blindness
  • Cerebrovascular Disease
  • Secondary hypertension (renal artery stenosis, pheo, etc.)
  • RAAS disease (Primary Aldosteronism, etc.)
  • Other chronic illness (cancer, autoimmune or liver disease)
  • Pregnancy
  • Anemia (Hgb < 12 mg/dl)
  • Evening or Night Shift work
  • Transmeridian travel in previous 6 months
  • History of sleep disorders
  • Hypokalemia (serum potassium < 3.5 milliequivalent (mEq/L)
  • Hyperkalemia (serum potassium > 5.5 mEq/L
  • Reported hypersensitivity to HCTZ or eplerenone
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 65 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT00515021
Other Study ID Numbers  ICMJE 070183
Has Data Monitoring Committee No
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement  ICMJE Not Provided
Responsible Party James Muldowney, Vanderbilt University Medical Center
Study Sponsor  ICMJE Vanderbilt University Medical Center
Collaborators  ICMJE National Center for Research Resources (NCRR)
Investigators  ICMJE
Principal Investigator: James A Muldowney, III, MD Vanderbilt University
PRS Account Vanderbilt University Medical Center
Verification Date January 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP