UMIN-CTR Clinical Trial

Unique ID issued by UMIN UMIN000007456
Receipt number R000008784
Scientific Title Mechanisms of antiproteinuric effects of azelnidipine in hypertensive patients with type 2 diabetes mellitus
Date of disclosure of the study information 2012/03/08
Last modified on 2014/09/07 21:25:21

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Basic information

Public title

Mechanisms of antiproteinuric effects of azelnidipine in hypertensive patients with type 2 diabetes mellitus

Acronym

Mechanisms of antiproteinuric effects of AzelnidiPine IN hypertensive patients with type 2 Diabetes Mellitus (MAP in DM)

Scientific Title

Mechanisms of antiproteinuric effects of azelnidipine in hypertensive patients with type 2 diabetes mellitus

Scientific Title:Acronym

Mechanisms of antiproteinuric effects of AzelnidiPine IN hypertensive patients with type 2 Diabetes Mellitus (MAP in DM)

Region

Japan


Condition

Condition

Essential hypertension with type 2 diabetes mellitus and proteinuria

Classification by specialty

Cardiology Endocrinology and Metabolism Nephrology

Classification by malignancy

Others

Genomic information

NO


Objectives

Narrative objectives1

Strict blood pressure (BP) control as well as inhibition of the renin-angiotensin system (RAS) is essential in the management of hypertensive patients with proteinuria. However, effective BP control is particularly difficult to achieve in patients with diabetes mellitus and target BP levels are seldom achieved with a standard dose of RAS inhibitors. Although calcium channel blockers are frequently used in combination with RAS inhibitors, the blockers have diverse characteristics; some calcium channel blockers, which inhibit N-type or T-type calcium channels, show antiproteinuretic effects similar to those of angiotensin converting enzyme inhibitors. Although azelnidipine, a calcium channel blocker, has been reported to produce potent antiproteinuretic effects, mechanisms underlying the beneficial effect are not clear because the compound has neither N-type nor T-type calcium channel blocking properties. Thus, the present study was designed to examine time-dependent changes in urinary excretion of protein, blood pressure, and several markers of kidney function after the start of treatment with azelnidipine in order to investigate the underlying mechanism.

Basic objectives2

Efficacy

Basic objectives -Others


Trial characteristics_1


Trial characteristics_2


Developmental phase



Assessment

Primary outcomes

(1) Changes in urinary excretion of albumin from baseline to 1, 2, 4, 12 weeks after randomization
(2) Changes in blood pressure and heart rate from baseline to 1, 2, 4, 12 weeks after randomization
(3) Changes in urine L-FABP, OHdG, sodium, and metanephrine from baseline to 1, 2, 4, 12 weeks after the treatment with azelnidipine
(4) Changes in serum creatinine, hs-CRP, IL-6, ADMA, cystatin C, and pentosidine from baseline to 1, 2, 4, 12 weeks after the treatment with azelnidipine
(5) Relationship of (1) with (2) , (3), (4), (5)

Key secondary outcomes

home BP, HbA1c


Base

Study type

Interventional


Study design

Basic design

Parallel

Randomization

Randomized

Randomization unit


Blinding

Open -but assessor(s) are blinded

Control

Active

Stratification


Dynamic allocation


Institution consideration


Blocking


Concealment



Intervention

No. of arms

2

Purpose of intervention

Treatment

Type of intervention

Medicine

Interventions/Control_1

MAP in DM is a 12-week, prospective, randomized, open, blinded-endpoint (PROBE) study. Type 2 diabetic patients with hypertension and proteinuria are recruited and antihypertensive medications are either started on or switched to a standard dose of an angiotensin receptor blocker (run-in-period). After a 3-month run-in period, baseline evaluations are performed and patients with BP =>130/80mmHg and urinary excretion of albumin =>300mg/g creatinine are enrolled. Then, patients are randomly assigned to receive either azelnidipine (16mg/day) or amlodipine (5mg/day) in combination with a standard dose of an angiotensin receptor blocker for additional 12 months. In cases that the target blood pressure level (<130/80mmHg) is not achieved, increasing doses of an alpha-blocker are prescribed to achieve the target level.

Interventions/Control_2

MAP in DM is a 12-week, prospective, randomized, open, blinded-endpoint (PROBE) study. Type 2 diabetic patients with hypertension and proteinuria are recruited and antihypertensive medications are either started on or switched to a standard dose of an angiotensin receptor blocker (run-in-period). After a 3-month run-in period, baseline evaluations are performed and patients with BP =>130/80mmHg and urinary excretion of albumin =>300mg/g creatinine are enrolled. Then, patients are randomly assigned to receive either azelnidipine (16mg/day) or amlodipine (5mg/day) in combination with a standard dose of an angiotensin receptor blocker for additional 12 months. In cases that the target blood pressure level (<130/80mmHg) is not achieved, increasing doses of an alpha-blocker are prescribed to achieve the target level.

Interventions/Control_3


Interventions/Control_4


Interventions/Control_5


Interventions/Control_6


Interventions/Control_7


Interventions/Control_8


Interventions/Control_9


Interventions/Control_10



Eligibility

Age-lower limit

20 years-old <=

Age-upper limit

80 years-old >=

Gender

Male and Female

Key inclusion criteria

Type 2 diabetic patients with essential hypertension and proteinuria are recruited and are either started on or switched to a monotherapy with a standard dose of an angiotensin receptor blocker for 3 months (run-in -period). Patients with BP =>130/80 mmHg and urinary excretion of albumin =>300mg/g creatinine at the end of run-in-period are finally enrolled.

Key exclusion criteria

Exclusion criteria are: secondary hypertension; history of acute coronary syndrome, heart failure, coronary revascularization, or stroke within the previous 6 months; uncontrolled diabetes mellitus (HbA1c >9.0%); confirmed or suspected renal artery stenosis; serum creatinine of 1.5mg/dl or more for men and 1.2mg/dl or more for women; contraindication to calcium channel blockers; pregnant women; or clinic systolic blood pressure >180mmHg and/or diastolic blood pressure >110mmHg.

Target sample size

30


Research contact person

Name of lead principal investigator

1st name
Middle name
Last name Masayoshi Kojima

Organization

Komono Kosei Hospital

Division name

Department of Internal Medicine

Zip code


Address

75 Fukumura, Komono-cho, Mie

TEL

059-393-1212

Email

m-kojima@kkh.miekosei.or.jp


Public contact

Name of contact person

1st name
Middle name
Last name Masayoshi Kojima

Organization

Komono Kosei Hospital

Division name

Department of Internal Medicine

Zip code


Address

75 Fukumura, Komono-cho, Mie

TEL

059-393-1212

Homepage URL


Email

m-kojima@kkh.miekosei.or.jp


Sponsor or person

Institute

Komono Kosei Hospital

Institute

Department

Personal name



Funding Source

Organization

Nagoya City university Graduate School of Medical Sciences

Organization

Division

Category of Funding Organization

Self funding

Nationality of Funding Organization



Other related organizations

Co-sponsor


Name of secondary funder(s)



IRB Contact (For public release)

Organization


Address


Tel


Email



Secondary IDs

Secondary IDs

NO

Study ID_1


Org. issuing International ID_1


Study ID_2


Org. issuing International ID_2


IND to MHLW



Institutions

Institutions



Other administrative information

Date of disclosure of the study information

2012 Year 03 Month 08 Day


Related information

URL releasing protocol


Publication of results

Unpublished


Result

URL related to results and publications


Number of participants that the trial has enrolled


Results


Results date posted


Results Delayed


Results Delay Reason


Date of the first journal publication of results


Baseline Characteristics


Participant flow


Adverse events


Outcome measures


Plan to share IPD


IPD sharing Plan description



Progress

Recruitment status

No longer recruiting

Date of protocol fixation

2012 Year 03 Month 01 Day

Date of IRB


Anticipated trial start date

2012 Year 03 Month 01 Day

Last follow-up date


Date of closure to data entry


Date trial data considered complete


Date analysis concluded



Other

Other related information



Management information

Registered date

2012 Year 03 Month 06 Day

Last modified on

2014 Year 09 Month 07 Day



Link to view the page

Value
https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000008784


Research Plan
Registered date File name

Research case data specifications
Registered date File name

Research case data
Registered date File name