Hypertension, Pulmonary
Conditions
Keywords
Pulmonary Arterial Hypertension
Brief summary
Clinical effect and tolerability of atorvastatin versus placebo in patients with Pulmonary Hypertension: double-blinded, randomised, prospective phase II study for 6 months with adjusted doses of Atorvastatin
Detailed description
PAH is characterized by dyspnea, fatigue, and lower extremity edema as a result of heart failure. Several research have proved that inflammation may participate in the pathogenesis of PAH. As atorvastatin inhibits inflammation and has beneficial effects on blood vessels in other types of cardiovascular disease. Therefore, atorvastatin may similarly benefit patients with PAH. Experimental data suggest that statins attenuates pulmonary hypertension in animal experiments. In addition, non-controlled clinical studies suggest that atorvastatin is effective and safe in patients with pulmonary hypertension. Participants in this study will be randomly assigned to receive 6 months of daily placebo tablets or daily atorvastatin in a double-blind fashion. The study will compare the safety and efficacy of placebo and atorvastatin.
Interventions
DRUGAtorvastatin
Patients were assigned to receive 10 mg of atorvastatin for 6 months (supplied by JiaLin Pharmaceutical Co., Beijing, China). The dose was adjusted to 5mg daily if serum transaminase levels increased by less than three times the upper limit of normal or creatine kinase levels increased to less than five times the upper limit of normal. If serum transaminase and creatine kinase levels remained normal and low-density lipoprotein level greater than 3.4mmol/L after 4 weeks of therapy, the dose of drug was increased to 20mg once daily.
DRUGPlacebo
Patients were assigned to receive 10 mg of placebo for 6 months (supplied by JiaLin Pharmaceutical Co., Beijing, China). The dose was adjusted to 5mg daily if serum transaminase levels increased by less than three times the upper limit of normal or creatine kinase levels increased to less than five times the upper limit of normal. If serum transaminase and creatine kinase levels remained normal and low-density lipoprotein level greater than 3.4mmol/L after 4 weeks of therapy, the dose of drug was increased to 20mg once daily.
Sponsors
National Grant from The Ministry of Science and Technology
Capital Development Scientific Fund
Chinese Academy of Medical Sciences, Fuwai Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Able to understand and willing to sign the informed consent form * \<=65 and \>=18years old * Diagnosis of pulmonary arterial hypertension (Mean pulmonary artery pressure greater than 25 mm Hg at rest with a pulmonary capillary wedge pressure less than 15 mm Hg )that is a) idiopathic, b) familial, or c) associated with connective-tissue disease, d)congenital systemic-to-pulmonary shunt occurring after surgical/interventional repair that had been performed at least five years previously or in the absence of indications for surgery/intervention treatment e) chronic thromboembolism PAH in the absence of indications for surgery * Patients in WHO functional class II to III * Vasodilator Testing nonresponders * Baseline six-minute walking distance between 100 and 460 m
Exclusion criteria
* PAH related to other etiologies (Groups 2, 3 and 5 pulmonary hypertension) * A forced expiratory volume in one second/ forced vital capacity bellow 50% or a total lung capacity of less than 60 percent predicted value * A 6-minute walk distance of less than 100 or more than 460 m * A positive acute vasodilator response * Current treatment with calcium-channel blockers or specific therapy (endothelin receptor antagonist, phosphodiesterase-5 inhibitor, or prostacyclin) * Inability to perform 6-minute walk test * Serum transaminase level three times above the upper limit of normal * Creatine kinase level five times above the upper limit of normal * Previously diagnosed heart disease such as serious cardiac arrhythmias, unstable angina pectoris, myocardial infarction * History of transient ischemia attack or stroke within three months * Bleeding disorder * Positive pregnancy test or breastfeeding practice * History or suspicion of inability to cooperate
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The placebo-corrected change from baseline to week 24 in 6-minute walk distance | Measured at 6 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time from randomization to clinical worsening | Measured at 6 months | Clinical worsening was defined as death, the first occurrence of hospitalization for pulmonary arterial hypertension, or initiation of PAH-specific drug therapy |
| Change from baseline to week 24 in World Health Organization functional class | measured at 6 monthes | World Health Organization (WHO) functional class: an adaptation of the New York Heart Association classification. |
| Change from baseline to week 24 in Borg dyspnea score | measured at 6 monthes | Borg dyspnea score: with 0 representing no dyspnea and 10 maximal dyspnea. |
| Change from baseline to week 24 in hemodynamic parameters derived from right heart catheterization. | measured at 6 monthes | Hemodynamic parameters: mean pulmonary artery pressure, right atrial pressure, cardiac index and pulmonary vascular resistance. |
Countries
China
Outcome results
None listed