Study of Cardiovascular Disease and Obstructive Sleep Apnea (CVD/OSA)

University of Wisconsin (UW)

Status and phase: Completed; Phase 2

Conditions: Hypertension; Severe Obstructive Sleep Apnea (Apnea Hypopnea Index > 30 Events/Hour)

Treatments: Drug: Placebo; Drug: Allopurinol; Drug: Losartan

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01637623

2012-0026

U01HL105365 (U.S. NIH Grant/Contract)

PHARM/PHARMACY/PHARMACY (Other Identifier)

A561000 (Other Identifier)

Details and patient eligibility

About

The purpose of this study is to determine if two medicines (allopurinol and losartan) can influence heart and blood vessel health compared to placebo in patients with sleep apnea who are using continuous positive airway pressure (CPAP).

Full description

The specific aims of this research project are: 1) Determine if treatment with losartan, an angiotensin type I receptor (AT1R) antagonist, or allopurinol, a XO inhibitor, normalize chemoreflex control of sympathetic outflow and ventilation and improve local vascular regulation and stiffness; and 2) Determine if these interventions reduce the severity of sleep disordered breathing and lower diurnal blood pressure.

Enrollment: 87 patients

Sex: All

Ages: 21 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Males and females between ages of 21 and 65 years
• Apnea hypopnea index or respiratory disturbance index greater than or equal to 25 events per hour
• Subjects eligible for CPAP or BiPAP therapy
• Hypertension by clinical history/diagnosis (may be controlled with non- exclusionary medications) or average blood pressure > 140/90 mm Hg (using last two measurements in prior 12 months - or 1 prior blood pressure and 1 blood pressure at screening)

Exclusion criteria

• If subject not using CPAP, having AHI > 60 events/hour or oxygen saturation ≤ 65% during sleep
• Presence of clinical CV disease (coronary artery disease, angina, arrhythmias (subjects with sinus arrhythmias will be reviewed by PI for enrollment), stroke, TIA, cor pulmonale, etc.), heart failure, bruits, or diabetes mellitus by clinical diagnosis/history
• Presence of pulmonary disease that results in significant hypoxemia (resting SaO2 < 88%)
• Hypertriglyceridemia (triglycerides >300 mg/dL), diabetes or impaired glucose tolerance (fasting plasma glucose > 125 mg/dL)
• Patients taking angiotensin converting enzyme inhibitors, angiotensin receptor antagonists, potassium-sparing diuretics (without accompanying loop/thiazide diuretic), allopurinol, oxypurinol, febuxostat, amoxicillin, ampicillin, azathioprine or mercaptopurine.
• Patients with chronic kidney disease (Serum creatinine >1.5 mg/dL) or history of significant hyperkalemia (Serum potassium > 5.2 mEq/L) with ARB therapy
• Patients with history of angioedema
• Patients with bilateral,modified radical or radical mastectomies
• Patients who have a Serum potassium > 5.0 mEq/L at the screening visit
• Female patients who are pregnant (determined by urine pregnancy test) or breastfeeding
• Patients with active MRSA or VRE (vancomycin resistant enterococcus) infection
• History of adverse reaction to allopurinol,losartan, or zolpidem**
• Patients who cannot swallow oral capsules
• Patients who are hospitalized or who have been recently hospitalized (last 2 weeks)
• Inability to comply with or complete the protocol or other reasons at the discretion of the investigators

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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87 participants in 3 patient groups, including a placebo group

Losartan

Active Comparator group

Description:

Losartan 50 mg daily for two weeks, then increased to 100mg daily for 4 weeks if asymptomatic and blood pressure within range.

Treatment:

Drug: Losartan

Allopurinol

Active Comparator group

Description:

Allopurinol 300 mg daily for 6 weeks

Treatment:

Drug: Allopurinol

Placebo

Placebo Comparator group

Description:

Placebo capsule daily for 6 weeks

Treatment:

Drug: Placebo