Tadalafil Effects in Left Ventricle Diastolic Dysfunction in Resistant Hypertensive Patients

University of Campinas, Brazil

Status: Completed

Conditions: Hypertension

Treatments: Drug: Tadalafil; Other: sugar pill

Study type: Interventional

Funder types: Other

Identifiers

NCT01743911

[2009/53430-7] (Other Identifier)

CAAE 0044.0.146.000-09

Details and patient eligibility

About

Left ventricle diastolic dysfunction (LVDD) is associated with resistant hypertension. In addition, brain natriuretic peptide (BNP) levels are elevated when LVDD is present. It has been shown that phosphodiesterase-5 (PDE5) inhibition improves left ventricle diastolic function in hypertensive rats, despite any difference in blood pressure levels. Also, left ventricle diastolic function enhancement reduces BNP concentration in hypertensive patients. However, it is unknown if these effects exists in humans with resistant hypertension. Therefore, this study was developed to evaluate if the use of a PDE5 inhibitor (tadalafil) for 2 weeks improves LVDD and its effects in BNP levels in resistant hypertensive patients.

Full description

Resistant hypertensive patients have a high incidence of left ventricle diastolic dysfunction (LVDD). Lowering blood pressure levels improves diastolic function, however, there is no proved effective treatment specifically for this disease. Studies in hypertensive rats have shown presence of phosphodiesterase-5 in cardiac cells and an improvement in left ventricle diastolic function using a phosphodiesterase-5 (PDE5) inhibitor, the sildenafil. PDE5 has also been demonstrated in human heart cells with cardiac disease. In addition, LVDD is associated with high levels of brain natriuretic peptide (BNP), which reduces with diastolic function improvement. Therefore, it is reasonable to suppose that PDE-5 inhibitor use in humans with LVDD and resistant hypertension could improve diastolic function. Objective: Evaluate the chronic effect of a PDE-5 inhibitor on LVDD and BNP levels in resistant hypertensive patients. Casuistic and methods: 20 resistant hypertensive patients with LVDD types I and II will be evaluated with echocardiography study, ambulatory blood pressure monitoring (ABPM), office blood pressure measurements, endothelial function analysis using the brachial artery flow mediation dilation technique (FMD) and BNP plasma levels. Then, the subjects will receive oral placebo for 2 weeks. After this period, the same exams will be repeated. Two weeks later, the protocol will be performed again to the same 20 patients, using tadalafil (the longest half-life PDE-5 inhibitor) 20mg orally instead of the placebo. Hypothesis: investigators hypothesize that the use of tadalafil will improve left ventricle diastolic function with BNP reduced levels and this effect will be independent of blood pressure decrease or endothelial function improvement.

Enrollment: 20 patients

Sex: All

Ages: 35 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• resistant hypertension (according to Resistant Hypertension - American Heart Association Statement - 2008);
• compliance with antihypertensive treatment;
• age >35 years;
• left ventricle diastolic dysfunction types I and II

Exclusion criteria

• valvulopathy
• decompensated heart failure
• important cardiac arrhythmias
• nephropathy
• hepatopathy
• autoimmune disease
• tabagism
• decompensated diabetes
• uncontrolled dislipidemia

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

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20 participants in 2 patient groups, including a placebo group

sugar pill

Placebo Comparator group

Description:

Intervention: sugar pill

Treatment:

Other: sugar pill

tadalafil

Active Comparator group

Description:

Intervention: tadalafil

Treatment:

Drug: Tadalafil