Studying the Effects of Antihypertensives on Individuals at Risk for Alzheimer's

NCT ID: NCT00980785

Last Updated: 2020-08-25

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE4
• Total Enrollment: 14 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2009-04-09
• Study Completion Date: 2011-07-26

Brief Summary

Angiotensin converting enzyme inhibitors (ACE-I) are a group of blood pressure-lowering medicines. Some studies suggest that ACE-I, such as ramipril, may help prevent Alzheimer's disease (AD). The purpose of the research is to see how ramipril affects a substance in the body called beta-amyloid. Beta-amyloid is found in the brain and in the liquid around the brain and spinal cord. High amounts of beta-amyloid may be associated with a greater risk of getting Alzheimer's disease. This study will see if ramipril can lower the amount of beta-amyloid in the spinal fluid. This study will also see if ramipril affects blood vessel function and memory and thinking. The investigators hope that future studies will show whether ramipril might prevent memory loss and decrease the chance of developing Alzheimer's disease.

Detailed Description

High blood pressure (BP) in midlife is predictive of Alzheimer's disease (AD) in later life. Similarly, reductions in BP are associated with protection against AD. Treatment with antihypertensive medications, specifically angiotensin converting enzyme inhibitors (ACE-I) such as ramipril, is associated with up to a 55% reduction in the prevalence of AD, suggesting a potentially promising role for ACE-I in the prevention of AD. It is unknown however 1) whether ACE-Is will have the same effect on Cerebrospinal fluid (CSF) Aβ levels in humans as in animal models 2) whether ACE-Is induce changes associated with vascular function (i.e. levels of CSF angiotensin converting enzyme (ACE) and peripheral endothelial function) and 3) whether there are interactions between ACE-I-induced changes in CSF Aβ, CSF ACE and indices of vascular function.

One mechanism by which antihypertensives may protect against AD is via Aβ neuropathology. In order to better understand the mechanisms through which ACE-I may modify CSF Aβ and possibly AD risk, we propose a randomized, double-blind, placebo-controlled pilot clinical trial, enrolling 20 middle-aged (age range 40 - 65 years), mildly hypertensive (between 130 - 160 mmHg mean systolic and between 85 - 100 mmHg mean diastolic) participants, who are adult children of an individual with AD. The main objective of this trial is to examine the effects of the ACE-I, ramipril, on 1) CSF Aβ levels 2) CSF ACE levels and 3) peripheral endothelial function as measured by brachial artery flow-mediated vasodilation (FMD) and aortic augmentation index (AAIx), in middle-aged adults with mildly elevated BP, who are at increased risk of developing AD.

Conditions

Alzheimer's Disease; Hypertension

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: DOUBLE

Study Groups

Placebo

Matching Placebo

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: DRUG

Matching Placebo

Active

Ramipril 5mg/day

Group Type: EXPERIMENTAL

Ramipril

Intervention Type: DRUG

Ramipril 5 mg/day

Interventions

Ramipril

Ramipril 5 mg/day

Intervention Type: DRUG

Placebo

Matching Placebo

Intervention Type: DRUG

Other Intervention Names

Altace

Eligibility Criteria

Inclusion Criteria

• Between the ages of 40 and 65
• Mean resting blood pressure between 130-160 systolic and 85-100 diastolic
• Parent with Alzheimer's Disease

Exclusion Criteria

• Current involvement in another investigational drug trial.
• Potassium > 5.0
• Dementia based on DSMIV criteria
• Mini-Mental State Exam (MMSE) score < 27
• Current blood pressure medication (< 4 months from screening)
• Weight loss medication
• Contraindications for LP
• Know diagnosis or history of hospitalization due to congestive heart failure
• Elevated creatinine (females > 1.3 mg/dL or males > 1.4 mg/dL at baseline)
• Diabetes Type I and II
• Know adverse reaction to an ACE-I or an angiotensin receptor blocker
• Pregnant of nursing women

• Minimum Eligible Age: 40 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

University of Wisconsin, Madison

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Cynthia M Carlsson, MD, MS

Role: PRINCIPAL_INVESTIGATOR

University of Wisconsin, Madison

Locations

Wisconisn Alzheimer's Disease Research Center

Madison, Wisconsin, United States

Countries

United States

References

Wharton W, Stein JH, Korcarz C, Sachs J, Olson SR, Zetterberg H, Dowling M, Ye S, Gleason CE, Underbakke G, Jacobson LE, Johnson SC, Sager MA, Asthana S, Carlsson CM. The effects of ramipril in individuals at risk for Alzheimer's disease: results of a pilot clinical trial. J Alzheimers Dis. 2012;32(1):147-56. doi: 10.3233/JAD-2012-120763.

Reference Type: BACKGROUND

PMID: 22776970 (View on PubMed)

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Related Links

http://wisconsinadrc.wisc.edu/prevention_research.shtml

Related Info

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3593582/

The Effects of Ramipril in Individuals at Risk for Alzheimer's Disease: Results of a Pilot Clinical Trial

Other Identifiers

H-2009-0036

Identifier Type: OTHER

Identifier Source: secondary_id

A534255

Identifier Type: OTHER

Identifier Source: secondary_id

SMPH/MEDICINE/GER-AD DEV

Identifier Type: OTHER

Identifier Source: secondary_id

2014-1353

Identifier Type: -

Identifier Source: org_study_id