Remote Ischaemic Conditioning in the Older Person and Effects on Dynamic Cerebral Autoregulation

NCT ID: NCT07179887

Last Updated: 2025-09-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

45 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-08-27

Study Completion Date

2027-09-30

Brief Summary

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Remote Ischaemic Conditioning (RIC) is the process of inducing short periods of ischaemia in a limb with the aim of improving vascular health systemically. Recent findings have demonsatrated efficacy in a variety of clinical settings. However, the ideal protocol of RIC \[dose\] is unknown. Dynamic Cerebral Autoregulation (dCA) has been shown to increase in response to RIC.

The goal of this trial is to study whether an increase in RIC protocol intensity results in a larger effect on biomarkers of vascular health such as dCA.

Participants shall:

Receive RIC daily, RIC thrice weekly or sham RIC thrice weekly for 6 weeks Visit the School of Medicine at baseline and at 6 weeks for measurement of biomarkers of vascular health including blood pressure, indices od dCA and blood plasma samples

Detailed Description

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Remote Ischaemic Conditioning (RIC) involves the delivery of short periods of ischaemia to a limb (using a blood pressure cuff), with the aim of promoting resilience to ischaemia in distant organs. It has shown promise as in intervention in both the treatment of acute ischaemic stroke and secondary prevention of cerebrovascular events. Various protocols exist ranging from single sessions of RIC delivered around the time of an ischaemic event, known as acute RIC, to repeated sessions delivered over days, weeks or even months, known as chronic RIC.

Preclinical work in animal models of stroke demonstrated consistent benefits of RIC. However, translation of these findings to human trials has yielded mixed results. Two large randomised controlled trials conducted in recent years have suggested benefit where RIC is given as a treatment following acute ischaemic stroke or when used in the secondary prevention of stroke in patients with symptomatic intracranial atherosclerosis. However, other clinical trials of RIC have yielded neutral results. For example, the RESIST trial, which used RIC as an intervention following both acute ischaemic and haemorrhagic stroke.

It is not known exactly why the promising findings in preclinical studies have not been replicated in human trials. It is likely that protocols of RIC, i.e. the 'dose', which proved effective in animal models of stroke, may not be sufficient when applied to multimorbid human populations who have also received current standard therapy. These therapies, such as antiplatelets, themselves provide cerebrovascular protection and may abrogate some of the benefit of RIC. It may be that more intense protocols of RIC, particularly chronic RIC, are needed to illicit benefit in humans.

To answer this question, work should be done to investigate the effect of RIC protocol intensity on vascular health in older adults. Too often in RIC research, there has been a rapid jump from preclinical study to large RCT. These RCTs initially used protocols of RIC based on those used in preclinical studies. With increasing awareness of the potential problems with this approach, RCTs now tend to use more intense protocols of RIC. However, very little work has been done examining the effect of RIC on biomarkers of vascular health to inform the choice of RIC dose, informing future trial design.

Dynamic cerebral autoregulation (dCA) is a measure of the regulation of cerebral blood flow in response to changes in systemic blood pressure. It has been shown to be impaired in the immediate post stroke period (≈2 weeks) and severely impaired autoregulation in the hours after stroke has been correlated with worse outcomes. Dynamic Cerebral Autoregulation has also been shown to improve in young adults given 2 weeks of RIC. We propose to conduct a further study in older adults, aged 65-85, investigating the effect of chronic RIC on biomarkers of vascular health including dCA and blood pressure (BP), comparing two difference dosing regimens.

Conditions

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Cerebral Autoregulation Blood Pressure Dynamic Cerebral Autoregulation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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High dose RIC

Daily sessions of RIC for 6 weeks. Each session will consist of 4 x 5 minute cuff inflation to 20mmHg above systolic blood pressure, interspersed with 5 minute periods of cuff deflation

Group Type EXPERIMENTAL

Remote Ischaemic Conditioning

Intervention Type DEVICE

Cuff inflation to 20mmHg abocve systolic blood pressure for cycles of 5 minutes. Each session will consist of 4 cycles of 5 minte inflation followed by 5 minute deflation. Total session time 40 minutes

Low dose RIC

3x weekly sessions of RIC for 6 weeks. Each session will consist of 4 x 5 minute cuff inflation to 20mmHg above systolic blood pressure, interspersed with 5 minute periods of cuff deflation

Group Type EXPERIMENTAL

Remote Ischaemic Conditioning

Intervention Type DEVICE

Cuff inflation to 20mmHg abocve systolic blood pressure for cycles of 5 minutes. Each session will consist of 4 cycles of 5 minte inflation followed by 5 minute deflation. Total session time 40 minutes

Sham RIC

3x weekly sessions of Sham RIC for 6 weeks. Each session will consist of 4 x 5 minute cuff inflation to 20mmHg only, interspersed with 5 minute periods of cuff deflation

Group Type PLACEBO_COMPARATOR

Sham Remote Ischaemic Conditioning

Intervention Type DEVICE

Cuff inlfation to 20mmHg only for cycles of 5 minutes. Each session will consist of 4 cycles of 5 minute inflation followed by 5 minutes of deflation. Total session time of 40 minutes

Interventions

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Remote Ischaemic Conditioning

Cuff inflation to 20mmHg abocve systolic blood pressure for cycles of 5 minutes. Each session will consist of 4 cycles of 5 minte inflation followed by 5 minute deflation. Total session time 40 minutes

Intervention Type DEVICE

Sham Remote Ischaemic Conditioning

Cuff inlfation to 20mmHg only for cycles of 5 minutes. Each session will consist of 4 cycles of 5 minute inflation followed by 5 minutes of deflation. Total session time of 40 minutes

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Participant is willing and able to give informed consent for participation in the study
* Participant aged 65 - 85
* Participant is able to perform RIC independently at home

Exclusion Criteria

* Active cardiovascular or cerebrovascular disease (acute event within the last 12 months)
* Atrial fibrillation or other significant arrhythmias
* Peripheral Vascular Disease
* Haemostatic disorders
* Soft tissue injury or fracture to the upper limb
* Pregnant or breast feeding
* History or current psychiatric illness
* History or current neurological condition (e.g. epilepsy)
* Inability to identify temporal window for transcranial doppler ultrasound at screening visit
* Any condition or presentation under current investigation that is deemed by the study clinician to exclude the participant from the study.
* Having taken part in a research study in the last 3 months involving invasive procedures or an inconvenience allowance
Minimum Eligible Age

65 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Leicester

OTHER

Sponsor Role collaborator

University of Nottingham

OTHER

Sponsor Role lead

Responsible Party

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Timothy England

Professor of Stroke Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Tim England, MBChB PhD

Role: PRINCIPAL_INVESTIGATOR

University of Nottingham

Locations

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School of Medicine, University of Nottingham, Royal Derby Hospital Centre

Derby, Derbyshire, United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Harry Keevil, MB BChir

Role: CONTACT

+441332 724676

Tim England, MBChB PhD

Role: CONTACT

+441332724676

Facility Contacts

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Harry Keevil, MB BChir

Role: primary

+441332 724676

Bethan E Phillips, BSc PhD

Role: backup

+441332 724676

References

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de Bruijn WC, Boeve ER, van Run PR, van Miert PP, Romijn JC, Verkoelen CF, Cao LC, Schroder FH. Etiology of experimental calcium oxalate monohydrate nephrolithiasis in rats. Scanning Microsc. 1994;8(3):541-9; discussion 549-50.

Reference Type BACKGROUND
PMID: 7747156 (View on PubMed)

Craft AW. Challenges in the management of bone tumors--1996. Ann N Y Acad Sci. 1997 Sep 17;824:167-79. doi: 10.1111/j.1749-6632.1997.tb46219.x. No abstract available.

Reference Type BACKGROUND
PMID: 9382441 (View on PubMed)

Hou C, Lan J, Lin Y, Song H, Wang Y, Zhao W, Li S, Meng R, Hao J, Ding Y, Chimowitz MI, Fisher M, Hess DC, Liebeskind DS, Hausenloy DJ, Huang J, Li Z, Han X, Yang J, Zhou J, Chen P, Zhu X, Hu P, Pang H, Chen W, Chen H, Li G, Tao D, Yue W, Gao Z, Ji X; RICA investigators. Chronic remote ischaemic conditioning in patients with symptomatic intracranial atherosclerotic stenosis (the RICA trial): a multicentre, randomised, double-blind sham-controlled trial in China. Lancet Neurol. 2022 Dec;21(12):1089-1098. doi: 10.1016/S1474-4422(22)00335-0. Epub 2022 Oct 27.

Reference Type BACKGROUND
PMID: 36354026 (View on PubMed)

Benedict MQ, McNitt LM, Cornel AJ, Collins FH. A new marker, black, a useful recombination suppressor, In(2)2, and a balanced lethal for chromosome 2 of the mosquito Anopheles gambiae. Am J Trop Med Hyg. 1999 Oct;61(4):618-24. doi: 10.4269/ajtmh.1999.61.618.

Reference Type BACKGROUND
PMID: 10548297 (View on PubMed)

Bell RM, Basalay M, Botker HE, Beikoghli Kalkhoran S, Carr RD, Cunningham J, Davidson SM, England TJ, Giesz S, Ghosh AK, Golforoush P, Gourine AV, Hausenloy DJ, Heusch G, Ibanez B, Kleinbongard P, Lecour S, Lukhna K, Ntsekhe M, Ovize M, Salama AD, Vilahur G, Walker JM, Yellon DM. Remote ischaemic conditioning: defining critical criteria for success-report from the 11th Hatter Cardiovascular Workshop. Basic Res Cardiol. 2022 Aug 15;117(1):39. doi: 10.1007/s00395-022-00947-2.

Reference Type BACKGROUND
PMID: 35970954 (View on PubMed)

Hougaard KD, Hjort N, Zeidler D, Sorensen L, Norgaard A, Hansen TM, von Weitzel-Mudersbach P, Simonsen CZ, Damgaard D, Gottrup H, Svendsen K, Rasmussen PV, Ribe LR, Mikkelsen IK, Nagenthiraja K, Cho TH, Redington AN, Botker HE, Ostergaard L, Mouridsen K, Andersen G. Remote ischemic perconditioning as an adjunct therapy to thrombolysis in patients with acute ischemic stroke: a randomized trial. Stroke. 2014 Jan;45(1):159-67. doi: 10.1161/STROKEAHA.113.001346. Epub 2013 Nov 7.

Reference Type BACKGROUND
PMID: 24203849 (View on PubMed)

Beighton D, Ludford R, Clark DT, Brailsford SR, Pankhurst CL, Tinsley GF, Fiske J, Lewis D, Daly B, Khalifa N, et al. Use of CHROMagar Candida medium for isolation of yeasts from dental samples. J Clin Microbiol. 1995 Nov;33(11):3025-7. doi: 10.1128/jcm.33.11.3025-3027.1995.

Reference Type BACKGROUND
PMID: 8576366 (View on PubMed)

Beilman GJ, Cerra FB. The future. Monitoring cellular energetics. Crit Care Clin. 1996 Oct;12(4):1031-42. doi: 10.1016/s0749-0704(05)70291-8.

Reference Type BACKGROUND
PMID: 8902383 (View on PubMed)

Other Identifiers

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FMHS 192-0625

Identifier Type: -

Identifier Source: org_study_id

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