Overview

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

Status:
Not yet recruiting
Trial end date:
2027-06-01
Target enrollment:
0
Participant gender:
All
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.
Phase:
Phase 2
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Rong Zhang
Collaborators:
Michigan State University
National Institute on Aging (NIA)
Texas Health Resources
Treatments:
Amlodipine
Angiotensin II
Angiotensin Receptor Antagonists
Angiotensinogen
Calcium
Calcium Channel Blockers
Giapreza
Losartan
Criteria
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.