Effect of Eplerenone on Endothelial Function in Metabolic Syndrome

• Status: Completed
• Trial end date: 2013-04-01
• Target enrollment: 0
• Participant gender: Male

Summary

Patients with the metabolic syndrome (MetSyn) are at increased risk for cardiovascular mortality and morbidity.This increased cardiovascular risk is attributed to metabolic dysregulations like impaired glucose tolerance or diabetes mellitus and dyslipidemia, abdominal obesity and arterial hypertension, which promote oxidative stress and inflammation with consecutive endothelial dysfunction causing an atherogenic environment.

Aldosterone promoted end organ damage is mainly found in the cardiovascular system and the kidney. Inflammation and activation of different factors promotes fibroblast growth and matrix production resulting in myocardial fibrosis, vascular remodelling and renal fibrosis.

MetSyn and aldosterone are cardiovascular risk factors and it is of crucial importance to note that there is a connection between MetSyn and aldosterone. Other cross sectional studies show a direct correlation of aldosterone levels and impaired glucose metabolism in patients with and without the MetSyn. Taken together, aldosterone influences essential parameters of the MetSyn. Coincidentally parameters of the MetSyn are stimulus for an increased aldosterone synthesis, i.e. visceral adipocytes.

In large scale clinical trials - RALES, EPHESUS, 4E - inhibition of MR has proven to be beneficial in patients with congestive heart failure and post myocardial infarction and this result has been confirmed for diabetic patients, who are known to have an increased cardiovascular risk.

There is only very limited data on the impact of MR inhibition on metabolic, endocrine, and inflammatory parameters in patients with MetSyn, who have not yet suffered from cardiovascular events.

• Phase: Phase 3
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University of Erlangen-Nürnberg Medical School
• Treatments: Eplerenone; Spironolactone

Criteria

• Male patients aged > 18 years with mild uncomplicated primary arterial hypertension with a mean sitting SBP ≥ 130 mmHg or DBP ≥ 85 mmHg or treated hypertension and at least 2 of the following traits of the metabolic syndrome (ATP III criteria):

• abdominal obesity (abdominal girth ≥ 102 cm in males),

• triglyceride level ≥ 150 mg/dL or treatment for elevated triglyzerides,

• HDL < 40 mg/dL or treatment for low HDL

• fasting blood glucose ≥ 100 mg/dL and ≤ 126 mg/dl.

• Written informed consent

• Agreement to attend all study visits as planned in the protocol

Exclusion Criteria:

• Patients with or without antihypertensive therapy and mean blood pressure > 160/100 mmHg

• Patients with secondary hypertension

• Patients with one antihypertensive agent maximally dosed or two (or less) agents with half (or less) of maximum approved dose

• Patients with diabetes mellitus type 1 or type 2

• Smokers and ex-smokers < 1 year

• Female patients (to prevent effects of changes in endothelial function attributable to the menstrual cycle)

• Patients with sick sinus syndrome

• Patients with higher degree of sinoatrial or atrioventricular block (II-III)

• Patients with bradycardia (< 50 beats/min)

• Patients with malignant arrhythmias

• Patients with known cardiovascular, disease

• Patients with known cerebrovacular disease

• Patients with peripheral occlusive artery disease

• Patients with history of epilepsy

• Patients with severe hepatic disease (serum GOT, GPT, gamma-GT, AP, bilirubin > 300 of uppper normal range)

• Patients with renal disease defined by eGFR < 60 ml/min/1,73m2

• Patients with history of malignant disease within the last 2 years

• Patients with history of depression

• Patients with drug or alcohol abuse

• Use of any investigational drug within 28 days before study entry

• Known allergy or a known intolerance to the study drug

• Likelihood of requiring treatment during the study period with drugs not permitted by the clinical study protocol, especially likelihood of the need for additional antihypertensive medication

• Serious disorders which may limit the ability to evaluate the efficacy or safety of the test drug(s), including cerebrovascular, cardiovascular, renal, respiratory, hepatic, gastrointestinal, endocrine or metabolic, haematological or oncological, neurological and psychiatric diseases

• Subject is the investigator or any subinvestigator, research assistant, pharmacist, study coordinator, other staff or relative thereof directly involved in the conduct of the protocol

• Mental conditions rendering the subject unable to understand the nature, scope and possible consequences of the study

• Subject unlikely to comply with protocol, e.g. uncooperative attitude, inability to return for follow-up visits and unlikelihood of completing the study