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Impact of Intensive Treatment of SBP on Brain Perfusion, Amyloid, and Tau (IPAT Study) (IPAT)

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ClinicalTrials.gov Identifier: NCT05331144
Recruitment Status : Recruiting
First Posted : April 15, 2022
Last Update Posted : December 2, 2022
National Institute on Aging (NIA)
Texas Health Resources
Michigan State University
Information provided by (Responsible Party):
Rong Zhang, University of Texas Southwestern Medical Center

Brief Summary:
The purpose of this study is to determine if intensive lowering of systolic blood pressure (SBP), using FDA approved medications (antihypertensive), reduces Alzheimer's Disease pathology (i.e., excessive brain amyloid and tau protein deposition) in older adults at high risk for memory decline or dementia.

Condition or disease Intervention/treatment Phase
Cognitively Normal Older Adults Hypertension Subjective Cognitive Decline Family History of Dementia Drug: Angiotensin II Receptor Blockers (ARBs, losartan) and Calcium Channel Blockers (CCB, amlodipine) Other: PCP Phase 2

Detailed Description:
The IPAT study is a 2-arm open-label randomized controlled trial to assess the effects of intensive pharmacological reduction of high blood pressure (SBP) on brain amyloid and tau protein deposition (Alzheimer's Disease pathology) in older adults who are at high risk for AD and related dementias, that is, those who have high blood pressure, family history of dementia, or subjective memory complaints. Furthermore, IPAT will examine effects of intensive blood pressure lowering on brain volume, perfusion, and neural network connectivity using magnetic resonance imaging (MRI) and cognitive performance.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 180 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Prevention
Official Title: Impact of Intensive Treatment of Systolic Blood Pressure on Brain Perfusion, Amyloid, and Tau in Older Adults (IPAT Study)
Actual Study Start Date : October 25, 2022
Estimated Primary Completion Date : June 1, 2027
Estimated Study Completion Date : June 1, 2027

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Amyloidosis

Arm Intervention/treatment
Experimental: Intensive Treatment (IT)
Lowering SBP < 120 mmHG
Drug: Angiotensin II Receptor Blockers (ARBs, losartan) and Calcium Channel Blockers (CCB, amlodipine)
Angiotensin II Receptor Blockers (ARBs, losartan) and Calcium Channel Blockers (CCB, amlodipine) will be used to treat high blood pressure. Additional antihypertensive medications may be used if needed.

Active Comparator: Usual Care (UC)
Participants will follow their PCP's recommendations for BP control
Other: PCP
Participants will follow their PCP's recommendations for BP control.

Primary Outcome Measures :
  1. Change From Baseline in Brain Fibrillar Beta-Amyloid Protein (Aβ) [ Time Frame: Baseline, 24 months ]
    Brain Aβ will be measured by annual change of amyloid mean cortical standardized uptake value ratio (SUVR) with positron emission tomography (PET).

Secondary Outcome Measures :
  1. Change From Baseline in Brain Tau Deposition [ Time Frame: Baseline, 24 months ]
    Brain Tau Deposition will be measured by tau temporal meta-ROI composite with positron emission tomography (PET).

  2. Change From Baseline in regional Cerebral Blood Flow (CBF) [ Time Frame: Baseline, 12 months, 24 months ]
    Regional CBF will be measured by MRI using arterial spin labeling.

  3. Change From Baseline in global Cerebral Blood Flow (CBF) [ Time Frame: Baseline, 12 months, 24 months ]
    Global CBF will be measured by PC-MRI and 2D color-coded duplex ultrasonography.

  4. Change From Baseline in Arterial Stiffness [ Time Frame: Baseline, 12months, 4 months ]
    Central arterial stiffness (pulse wave velocity and carotid β-stiffness index) will be measured by artery applanation tonometry.

  5. Change From Baseline in Amplitude of Low Frequency Fluctuations of Blood-Oxygen-Level-Dependent Signal (BOLD ALFF) [ Time Frame: Baseline, 12 months, 24 months ]
    BOLD ALFF will be measured by resting state functional MRI (rs-fMRI).

  6. Change From Baseline in White Matter Hyperintensity Volume [ Time Frame: Baseline, 12 months, 24 months ]
    White matter hyperintensity volume will be measured by MRI using 3D T2 FLAIR sequence .

  7. Change From Baseline in Brain Neural Network Connectivity [ Time Frame: Baseline, 12 months, 24 months ]
    Brain neural network connectivity will be measured by rs-fMRI.

  8. Change From Baseline in Neurocognitive Function [ Time Frame: Baseline, 12 months, 24 months ]
    A composite z score will be obtained by conversion of individual test scores of the Preclinical Alzheimer Cognitive Composite (PACC) and the NIH Toolbox Cognition Battery to standardized z scores, then averaged to assess changes in global cognitive function. Domain-specific z scores will be used to assess specific domains of cognitive function (i.e., memory, executive function, language etc.).

Information from the National Library of Medicine

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Ages Eligible for Study:   60 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age 60-80, all races/ethnicities, and both sexes are eligible;
  • a) A positive family history of dementia defined as having at least one first-degree relative with a history of AD or other type of dementia or
  • b) having subjective memory complaints defined as a positive answer to BOTH of the following questions:

    1. "Are you worried about your memory or thinking abilities?

      a) Not at all, b) A little bit, c) A lot"; B and C - includes

    2. "Do you feel you have difficulty with your memory or thinking that is worse than in the past?" b) Yes or No; Yes - includes
  • Mini-Mental State Exam (MMSE) ≥ 26 to exclude gross dementia; based on clinical judgment, may be rescreened in ≥ 7 days;
  • Individuals with SBP ≥ 130 and SBP ≤ 180; Those on antihypertensives are eligible. If an individual, not treated for HTN, has a SBP ≥ 125 mmHg, consider rescreening after 24 hours;
  • Willingness to be randomized into the treatment groups and ability to return to clinic for follow-up visits over 24 months;
  • Fluency in English or Spanish or both, adequate visual and auditory acuity to allow neuropsychological testing;
  • Participants must have a regular healthcare provider.

Exclusion Criteria:

  • Clinically documented history of stroke, focal neurological signs or other major cerebrovascular diseases based on clinical judgment or MRI/CT scans such as evidence of infection, infarction, or other brain lesions;
  • Diagnosis of AD or other type of dementia, or significant neurologic diseases such as Parkinson's disease, seizure disorder, multiple sclerosis, history of severe head trauma or normal pressure hydrocephalus;
  • Evidence of severe major depression (GDS ≥ 12, may be rescreened after 12 weeks or longer if evidence of reactive depression or temporary mood disturbances) or clinically significant psychopathology, (e.g., psychosis and schizophrenia); if hospitalized in past year, can be rescreened in 6 months; or presence of a major psychiatric disorder that in the investigator's opinion, could interfere with adherence to research assessments or procedures.
  • Unstable heart disease based on clinical judgment (e.g., heart attack/cardiac arrest, cardiac bypass procedures within previous 6 months and congestive heart failure), or other severe medical conditions;
  • History of atrial fibrillation and evidence on ECG with any of the following: active symptoms of persistent palpitation, dizziness, history of syncope, chest pain, dyspnea, orthopnea, shortness of breath at rest, or paroxysmal nocturnal dyspnea within the past 6 months; resting heart rate of < 30 or > 110 bpm; taking class I or III antiarrhythmic drugs including flecainide, propafenone, dronedarone, sotalol, dofetilide, and amiodarone; or clinical concerns for safely participating in lowering blood pressure.
  • Systolic BP equal or greater than 180 mmHg and/or diastolic BP equal or greater than 110 mmHg, may be rescreened in 1 week.
  • Orthostatic hypotension, defined as the third standing SBP < 100mmHg, may be rescreened after 2 weeks;
  • History of significant autoimmune disorders such as systemic lupus erythematosus, rheumatoid arthritis or polymyalgia rheumatica;
  • Significant history of alcoholism or drug abuse within the last five years;
  • Uncontrolled diabetes mellitus, defined as hemoglobin A1C > 6.5%, or requiring insulin treatment;
  • Clinically diagnosed and untreated sleep apnea;
  • Regularly smoking cigarettes within the past year;
  • Pacemaker or other medical device of metal that precludes performing MRI;
  • Women with a potential for pregnancy, lactation/childbearing (2 year post-menopausal or surgically sterile to be considered not childbearing potential);
  • Participant enrolled in another investigational drug or device study, either currently or within the past 2 months;
  • Severe obesity with BMI > 40 ; clinical judgment should be applied in all cases to assess patient safety and anticipated compliance;
  • Allergy to angiotensin receptor blockers (ARBs), i.e., drugs that have a suffix "-sartan"; allergy to amlodipine;
  • Abnormal screening laboratory tests (e.g., liver ALT and AST > 3 x ULN, GFR < 30 or Hct < 28%); may be rescreened after 2 weeks or longer;
  • A medical condition likely to limit survival to less than 3 years;
  • Participant has any condition(s) judged by the study investigator to be medically inappropriate, risky or likely to cause poor study compliance. For example:

    1. Plans to move outside the clinic catchment area in the next 2 years;
    2. Significant concerns about participation in the study from spouse, significant other, or family members;
    3. Lack of support from primary health care provider;
    4. Residence too far from the study clinic site such that transportation is a barrier including persons who require transportation assistance provided by the study clinic funds for screening or randomization visits;
    5. Residence in a nursing home; persons residing in an assisted living or retirement community are eligible if they meet the other criteria;
    6. Other medical, psychiatric, or behavioral factors that, in the judgment of the site PI or clinician, may interfere with study participation or the ability to follow the study Protocol.
    7. Couples or significant partners who live together cannot be enrolled or participate simultaneously in the study.

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): NCT05331144

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Contact: Tristyn Hall-Curtis, MBA 2143454245 TristynHall@texashealth.org

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United States, Texas
University of Texas Southwestern Medical Center Recruiting
Dallas, Texas, United States, 75390
Contact: Tristyn Hall-Curtis, MBA    214-345-4245    TristynHall@texashealth.org   
Principal Investigator: Rong Zhang, PhD         
Principal Investigator: Wanpen Vongpatanasin, MD         
Sponsors and Collaborators
Rong Zhang
National Institute on Aging (NIA)
Texas Health Resources
Michigan State University
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Principal Investigator: Rong Zhang, PhD University of Texas Southwestern Medical Center
Principal Investigator: Wanpen Vongpatanasin, MD University of Texas Southwestern Medical Center
Principal Investigator: David Zhu, PhD Michigan State University
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Responsible Party: Rong Zhang, Professor of Medicine, University of Texas Southwestern Medical Center
ClinicalTrials.gov Identifier: NCT05331144    
Other Study ID Numbers: STU-2021-1210
1R01AG076660-01 ( U.S. NIH Grant/Contract )
First Posted: April 15, 2022    Key Record Dates
Last Update Posted: December 2, 2022
Last Verified: December 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: All of the individual participant data collected during the trial, after deidentification.
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Time Frame: At the time of publication of the primary results or within 9 months of the database lock whichever comes first.
Access Criteria: The Study Steering Committee (SC) will review and approve the Data and Resource Sharing (DRS) requests from qualified investigators. A Material Transfer Agreement (MTA) and Data Use Agreement (DUA) will be in place with any academic group or scientists before any transfer of bio-samples or other data. Investigators receiving the data and/or samples will be required to abide by the conditions of these agreements. We will make the data and associated documentation available to other investigators only under a data-sharing agreement that provides for: (1) a commitment to using the data only for research purposes and not to identify any individual participant; (2) a commitment to securing the data using appropriate technology; and (3) a commitment to destroying or returning the data after analyses are completed.

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Rong Zhang, University of Texas Southwestern Medical Center:
Alzheimer's Disease
Cognitive Function
Blood Pressure
Additional relevant MeSH terms:
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Cognitive Dysfunction
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Neurocognitive Disorders
Mental Disorders
Cognition Disorders
Calcium Channel Blockers
Angiotensin II
Angiotensin Receptor Antagonists
Calcium-Regulating Hormones and Agents
Physiological Effects of Drugs
Antihypertensive Agents
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Vasodilator Agents
Anti-Arrhythmia Agents
Angiotensin II Type 1 Receptor Blockers
Vasoconstrictor Agents
Serine Proteinase Inhibitors
Protease Inhibitors
Enzyme Inhibitors