Body Volume Regulation in Pulmonary Arterial Hypertenison With Right Ventricular Failure - Full Text View

Sponsored by:	University of Colorado at Denver and Health Sciences Center
Information provided by:	University of Colorado at Denver and Health Sciences Center
ClinicalTrials.gov Identifier:	NCT00811486

Purpose

Secondary hyperaldosteronism and the non-osmotic release of arginine vasopressin (AVP) are the major factors in sodium and water retention in pulmonary arterial hypertension with right ventricular failure. Natriuretic doses of mineralocorticoid antagonist and aquaretic doses of V2 receptor antagonist will attenuate the sodium and water retention respectively, and be associated with clinical improvement.

Condition	Intervention
Right Heart Failure Pulmonary Hypertension	Drug: Spironolactone and conivaptan Other: usual care

MedlinePlus related topics: Drinking Water Heart Failure High Blood Pressure Pulmonary Hypertension

Drug Information available for: Spironolactone Conivaptan

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Treatment, Randomized, Open Label, Uncontrolled, Parallel Assignment, Efficacy Study
Official Title:	Body Volume Regulation in Pulmonary Arterial Hypertenison With Right Ventricular Failure

Further study details as provided by University of Colorado at Denver and Health Sciences Center:

Primary Outcome Measures:

Cross sectional study: Correlation between severity of pulmonary hypertension and neurohumoral activation, RBF & TPV. Acute study:electrolyte-free water and sodium excretion. Cohort Study: Composite of CI, BNP and RAP [ Time Frame: 18 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Cross-sectional Study: correlations between mean pulmonary artery pressure, pulmonary vascular resistance; and neurohumoral activation, GFR and TPV. Acute study:correlation between response to drug and severity of disease. [ Time Frame: 18 months ] [ Designated as safety issue: No ]

Estimated Enrollment:	26
Study Start Date:	January 2009
Estimated Study Completion Date:	December 2010
Estimated Primary Completion Date:	July 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Usual care Group II	Other: usual care diuretics, PAH specific therapy, O2
Spironolactone: Experimental Group I	Drug: Spironolactone and conivaptan Tablet, 50 mg to 200 mg, daily, orally 20 mg intravenously one time over 30 minutes

Detailed Description:

Much has been learned about the pathophysiological state that underlies the development of increased total body volume and edema in left ventricular failure. Very little, however, is known about the mechanism underlying systemic hypervolemia in patients with isolated right ventricular dysfunction.

Patients with pulmonary arterial hypertension (PAH) represent a model of isolated right ventricular dysfunction in which these mechanisms may be elucidated. Aldosterone has now been shown to have many properties that are likely to be detrimental in congestive heart failure (CHF) and that are not shared by angiotensin II. Aldosterone blockade has been associated with improved mortality in patients with left ventricular failure, already receiving an angiotensin converting enzyme inhibitor. But its role in isolated right ventricular failure has not been elucidated. The plasma arginine vasopressin levels are disproportionately elevated for the degree of serum osmolarity in patients with heart failure and result in water retention and hyponatremia.

Conivaptan, a vasopressin receptor antagonist, appears to reduce body weight and improve signs of left heart failure, though there is no study to evaluate its role in right ventricular failure with edema. This study will examine the role of spironolactone and conivaptan in patients with right ventricular failure and pathophysiology of sodium and water retention in these patients.

Eligibility

Ages Eligible for Study:	18 Years to 75 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

1. Patients with WHO group 1 pulmonary arterial hypertension [51], excluding patients with portal hypertension, meeting the following hemodynamic parameters:

Mean pulmonary artery pressure (mPAP) >35 mmHg at rest, and
Pulmonary capillary wedge pressure (PCWP) <15 mmHg, and
Pulmonary vascular resistance (PVR) >1.5 wood units, and 2. Age 18 to 75 years 3. Right ventricular failure defined by right atrial pressure >7 mmHg along with either dilated right ventricle, or absence of inferior vena cava collapse or BNP >100 pg/ml 4. Patients of childbearing age must be practicing effective birth control. 5. Normal left ventricular function as assessed by echocardiogram, multiple gated acquisition (MUGA) cardiac scan, or invasive left ventriculography.

Exclusion Criteria:

1. Group 2-5 pulmonary hypertension as defined by WHO.

Pulmonary hypertension with left heart failure (as assessed by echocardiogram, multiple gated acquisition (MUGA) cardiac scan, or invasive left ventriculography).
Pulmonary hypertension associated with lung disease and/or hypoxemia (e.g. chronic obstructive pulmonary disease, interstitial lung disease, sleep disordered breathing, chronic exposure to high altitude, alveolar hypoventilation syndrome.
Pulmonary hypertension due to chronic thrombotic and/or embolic diseases
Miscellaneous such as sarcoidosis, compression of pulmonary vessels by adenopathy, tumor 2. Systemic hypertension, defined as a systolic pressure >140 mmHg or a diastolic blood pressure >90mmHg 3. Patients taking angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blockers (ARBs) 4. Pregnancy 5. Chronic kidney disease (serum creatinine > 2.5mg/dl, proteinuria >500 mg/day, hematuria) 6. Cirrhosis or portal hypertension 7. Inability to provide informed consent. 8. Allergy to conivaptan or spironolactone. 9. Active malignancy 10. Patients receiving spironolactone 11. Enrollment in other interventional studies. 12. Patients on HAART

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00811486

Contacts

Contact: Shweta Bansal, MD	303-266-9220	shweta.bansal@uchsc.edu
Contact: Robert W Schrier, MD	303-724-4837	robert.schrier@cudenver.edu

Locations

United States, Colorado
University of Colorado at Denver and Health Sciences Center General Clinical Research Center
Denver, Colorado, United States, 80262

Sponsors and Collaborators

University of Colorado at Denver and Health Sciences Center

Investigators

Principal Investigator:

Shweta Bansal, MD

UCHSC

More Information

No publications provided

Responsible Party:	University of Colorado at Denver and Health Sciences Center ( Shweta Bansal )
Study ID Numbers:	07-1022
Study First Received:	December 18, 2008
Last Updated:	December 18, 2008
ClinicalTrials.gov Identifier:	NCT00811486 History of Changes
Health Authority:	United States: Institutional Review Board

Study placed in the following topic categories:

Heart Failure
Heart Diseases
Hormone Antagonists
Diuretics
Vascular Diseases
Hormones, Hormone Substitutes, and Hormone Antagonists
Cardiovascular Agents

Hormones
Spironolactone
Respiratory Tract Diseases
Aldosterone Antagonists
Hypertension, Pulmonary
Lung Diseases
Hypertension

Additional relevant MeSH terms:

Heart Failure
Heart Diseases
Hormone Antagonists
Diuretics
Physiological Effects of Drugs
Hormones, Hormone Substitutes, and Hormone Antagonists
Vascular Diseases
Cardiovascular Agents
Pharmacologic Actions

Spironolactone
Aldosterone Antagonists
Respiratory Tract Diseases
Hypertension, Pulmonary
Natriuretic Agents
Therapeutic Uses
Lung Diseases
Cardiovascular Diseases
Hypertension

ClinicalTrials.gov processed this record on May 07, 2009