NT-proBNP Selected Prevention of Cardiac Events in Diabetic Patients

Recruiting now · Phase 4

Conditions studied: Heart Diseases, Diabetes Mellitus, Type 2

In brief

Purpose and rationale The purpose of this study is to evaluate the effect of high dose Renin-Angiotensin System (RAS)-antagonists and beta-blocker treatment for the primary prevention of cardiac events in a population of patients with Type 2 diabetes mellitus (T2DM) with no evidence of a preexisting cardiac disease. An additional aim is to demonstrate an interaction between concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP as a surrogate of imminent cardiac risk) and treatment effects and the economic impact of the intervention overall and in the biomarker stratified subgroups. Primary objective Superiority of high dose treatment with RAS-antagonists and beta-blockers compared to conventional therapy regarding the reduction of unplanned hospitalization or death due to a cardiac event in T2DM patients with a NT-proBNP \> 125pg/ml. There is an additional eye-substudy for Viennese sites only. The purpose of this sub-study is to evaluate the effect of high dose RAS-antagonists and beta blocker treatment on early subclinical signs of diabetic micro-angiopathy and neuropathy. An additional aim will be the evaluation of the possible impact of the cardiovascular risk factor NT-proBNP on the onset and progression of diabetic retinopathy.

Key facts

Study ID

NCT02817360

Run by

Martin Huelsmann

People needed

2400

Starts

2016-02-01

Expected to finish

2026-12-01

Last updated by the study team

2023-03-14

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Type-2 diabetes for at least six months,
• ≥ 18 years of age, men or female,
• Written informed consent to participate in the study and ability to comply with all requirements.

You may not qualify if…

• History of hypersensitivity to any of the investigated drugs as well as known or suspected contraindications to the study drugs or previous history of intolerance to high dose of RAS-Antagonist or Beta-blocker in the absence of any other blood pressure lowering drugs.
• Patients already on maximum dose of RAS-antagonist or beta-blocker.
• Creatinine > 2.5mg/dl.
• Symptomatic hypotension and/or systolic blood pressure (SBP) < 100 mmHg at Visit 1.
• Symptomatic bradycardia and/or heart rate (HR) < 60 bpm at Visit 1
• Signs of cardiac disease in the ECG such as atrial fibrillation; ST-T abnormalities or any bundle branch block / higher degree atrioventricular (AV) block.
• Abnormal echocardiography, defined as low ejection fraction < 50%; wall motion abnormalities suggesting coronary artery disease (CAD), significant valve dysfunction > grade I or other significant alteration.
• Coronary artery disease, defined by a history of myocardial infarction, known coronary stenosis > 70% detected either by angiography or by CT-scan, significant defects in myocardial scintigraphy or positive stress-test echocardiography.
• A disease other than T2DM lowering the patient's life expectancy to less than two years.
• Chronic infections or malignancies.
• Systemic treatment with corticosteroids.
• Renal replacement therapy.
• Women of child-bearing potential (WOCBP), defined as all women physiologically capable of becoming pregnant, including women whose career, lifestyle, or sexual orientation precludes intercourse with a male partner and women whose partners have been sterilized by vasectomy or other means, UNLESS they meet the following definition of post-menopausal: 12 months of natural (spontaneous) amenorrhea or 6 months of spontaneous amenorrhea with serum Follicle Stimulating Hormone (FSH) levels > 40 mIU/m or 6 weeks post surgical bilateral oophorectomy with or without hysterectomy OR are using one or more of the following acceptable methods of contraception: surgical sterilization (e.g., bilateral tubal ligation), hormonal contraception (implantable, patch, and oral), and double-barrier methods (if accepted by local regulatory authority and ethics committee). Reliable contraception should be maintained throughout the study and for 7 days after study drug discontinuation.
• Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive Human Chorionic Gonadotropin (hCG) laboratory test (> 5 U/ml).
• History of noncompliance to medical regimes and patients who are considered potentially unreliable.
• Current double blind treatment in diabetic trials.
• Participation in an investigational drug study at the time of enrollment or within the past 90 days.
• Eligibility criteria for eye-substudy:
• Inclusion criteria:
• Participation in the PONTIAC 2 Study
• Written informed consent to participate in the eye-study
• Exclusion criteria:
• Media opacities like cataract or vitreous hemorrhage
• Active intraocular inflammation (grade trace or above) in either eye like infectious conjunctivitis, keratitis, scleritis, endophthalmitis as well as idiopathic or autoimmune-associated uveitis in either eye
• Structural damage to the center of macula in the study eye

Where it is running

• Universitätsklinik für Augenheilkunde und Optometrie Medizinische Universität Wien — Vienna, Austria (enrolling)
• Diabetes & Stoffwechselambulanz Gesundheitszentrum Wien Süd — Vienna, Austria (enrolling)
• Ninewells Hospital, Diabetes Support Unit — Dundee, United Kingdom (enrolling)
• Queen Elisabeth University Hospital, Glasgow Clinical Research Facility — Glasgow, United Kingdom (enrolling)
• North Manchester General Hospital, Diabetes centre — Manchester, United Kingdom (enrolling)
• Christchurch Heart Institute — Christchurch, New Zealand (enrolling)
• Klinischen Abteilung für Endokrinologie und Diabetologie MU Graz — Graz, Styria, Austria (enrolling)
• iMED19 — Vienna, Austria (enrolling)
• Konventhospital der Barmherzigen Brüder Abteilung für Innere Medizin — Linz, Upper Austria, Austria (enrolling)
• Hospital de la Santa Creu i Sant Pau, Unitat de Diabetis, Servei d'Endocrinologia i Nutrició, Universitat Autònoma de Barcelona — Barcelona, Spain (enrolling)
• Hospital Universitari Germans Trias i Pujol, l'Institut del Cor — Barcelona, Spain (enrolling)
• Medical University of Vienna Univ.Clinic for Internal Medicine II Department of Cardiology — Vienna, Austria (enrolling)
• Univ. Klinik für Innere Medizin III Med. Uni Wien — Vienna, Austria (enrolling)
• Woodseats Medical Centre — Sheffield, United Kingdom
• Maastricht University Medical Center; Dep. Cardiology — Maastricht, Netherlands
• Internistische Ordination — Mödling, Lower Austria, Austria
• Krankenanstalt Rudolfstiftung, 1. Medizinische Abteilung — Vienna, Austria
• Zentrum für Klinische Studien — Vienna, Austria
• 3. Med. Abtlg., KH Hietzing mit Neurologischem Zentrum Rosenhügel — Vienna, Austria
• Nethergreen Surgery — Sheffield, United Kingdom
• Ecclesfield Group Practice — Sheffield, United Kingdom

Full record on ClinicalTrials.gov

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