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HypertensionPhase 4NCT02102243

Neural Mechanism of Aldosterone-induced Insulin Resistance

A Phase 4 study testing DEFINITY® infusion, Human Recombinant Regular Insulin infusion and Dextrose infusion in people with Hypertension, run by Wanpen Vongpatanasin at 1 site in United States.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial summary

Patients with high aldosterone hormone have higher blood glucose than normal people. This study is being done to understand how aldosterone hormone affects the nerve activity that controls blood flow in the muscles and blood glucose. Read more about this study

Who is it for?
Ages 18 to 75 yearsHealthy volunteers can take part
Conditions the study is for
Hypertension
What is being tested?
DEFINITY® infusion, Human Recombinant Regular Insulin infusion and Dextrose infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
0 participants
Where
1 siteUnited States
Study dates
Nov 2010to Dec 2025
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Normotensive controls
  • Stage I (140-159/90-99 mmHg) untreated subjects with essential hypertension
  • Patients with PA and stage I (140-159/90-99 mmHg) hypertension

Who cannot join

  • Congestive heart failure or coronary artery disease
  • Blood pressure averaging > 159/99 mmHg
  • Serum creatinine > 1.5 mg/dL
  • Diabetes mellitus or other systemic illness
  • Left ventricular hypertrophy by echocardiography or ECG
  • Pregnancy
Show all 11Show fewer
  • Hypersensitivity to spironolactone, chlorthalidone, amlodipine, human recombinant insulin or Definity
  • Any history of substance abuse (other than tobacco)
  • History of gouty arthritis
  • Patients with right-to-left, bi-directional, or transient right-to-left cardiac shunts
  • Hypersensitivity to perflutren, blood, blood products or albumin

Trial locations and contacts

1 site in 1 country.

United States1 site
  • UT Southwestern Medical Center

    Dallas, Texas, 75390

Other trials in United States

About this study

Official title: The Role of Aldosterone on Sympathetic Nerve Activity and Insulin Sensitivity

Patients with high aldosterone hormone have higher blood glucose than normal people. This study is being done to understand how aldosterone hormone affects the nerve activity that controls blood flow in the muscles and blood glucose. The information may be helpful in selecting blood pressure medications which can improve not only blood pressure but also improve blood sugar.

Read the detailed description

Patients with primary aldosteronism are known to have impaired insulin sensitivity, which is improved after removal of aldosterone-producing adenoma. In patients with essential hypertension, plasma aldosterone levels have been also shown to positively correlate with indices of insulin resistance.

Mechanism underlying aldosterone-induced insulin resistance is unknown. Aldosterone has been shown to interfere with insulin signaling the vascular cells by increasing production of reactive oxygen species via activation of NADPH oxidase, resulting in decreased availability of nitric oxide (NO), the key mediator for insulin-mediated vasodilation. Treatment with mineralocorticoid receptor antagonists has been shown to improve insulin sensitivity in mice with obesity and metabolic syndrome. Aldosterone has also been shown to increase resting sympathetic vasoconstrictor activity to the peripheral circulation. However, effects of aldosterone and mineralocorticoid receptor antagonists on insulin-mediated skeletal muscle vasodilation, sympathetic activation, and vascular oxidative stress have not been assessed in humans.

The investigators will collect venous endothelial cells, and measure skeletal muscle microvascular perfusion using Octafluoropropane microbubble contrast agents, and measure sympathetic nerve activity in normotensive controls (NT), stage 1 essential hypertensive subjects (ET), and patients with primary aldosteronism (PA) during hyperinsulinemic euglycemic clamp.

Conditions
Hypertension
Being tested
DEFINITY® infusion, Human Recombinant Regular Insulin infusion, Dextrose infusion, Flow mediated vasodilation, Endothelial cell collection
Keywords
hypertension, blood pressure, sympathetic nerve activity, vascular oxidative stress, nitric oxide, nitric oxide synthase (eNOS), endothelium, endothelial dysfunction, endothelial cell protein expression, microvascular blood flow, flow mediated dilation, endothelial cell collection, microbubbles, Definity
Medical subject headings
Hypertension

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • DEFINITY® infusionDrug

    Also called (IND# 104397)

    The DEFINITY® vial contains components that upon activation yield perflutren lipid microspheres, a diagnostic drug that is intended to be used for contrast enhancement during echocardiographic procedures. The vial contains a clear, colorless, sterile, non-pyrogenic, hypertonic liquid, which upon activation with agitation, provides a homogeneous, opaque, milky white injectable suspension of perflutren lipid microspheres. The suspension of activated DEFINITY® will be infused intravenously at a rate of 0.20 to 0.27 ml/min, not to exceed a maximum dose of 2 vials per study subject per day or visit.

  • Human Recombinant Regular Insulin infusionDrug

    Also called Humulin R, National Drug Code # 0002-8501-01

    The plasma insulin concentration will be acutely raised and maintained at at a steady state by a prime-continuous insulin infusion.

  • Dextrose infusionDrug

    Also called Dextrose 20%

    The plasma glucose concentration will be held constant at 90 mg/dl by a variable glucose infusion during euglycemic hyperinsulinemic clamp

  • Flow mediated vasodilationProcedure or surgery

    Also called FMD, Endothelial Dependent Vasodilation

    Flow mediated vasodilation (FMD), which is a non-invasive assessment of endothelial function, will be performed on the brachial artery using ultrasound. After a clear picture of the artery has been obtained, the cuff on the same arm will be inflated until it is tight for five minutes. During and following this, the subject's arm will continue to be imaged to monitor maximal increase in the brachial artery diameter.

  • Endothelial cell collectionProcedure or surgery

    We will collect endothelial cells from a superficial vein, usually in the arm. Following insertion of a peripheral intravenous (IV) catheter, we will collect cells from the inner lining of the vein using a thin, flexible J-tipped wire. The wire will be inserted through the IV into the vein and then removed, along with a sampling of endothelial cells. The cells collected will be processed and stained for several proteins involved in endothelial cell function, using immunofluorescent technique.

  • Microvascular perfusion assessment using DefinityProcedure or surgery

    Using high-resolution ultrasound, we will measure skeletal muscle blood flow during infusion of a solution containing the octafluoropropane microbubble contrast agent, Definity. The solution will be a dilution of 1 vial of Definity to 30 cc of normal saline. The ultrasound probe will be placed over the forearm to obtain images while octafluoropropane microbubbles (Definity) are infused intravenously at the rate of 0.20 to 0.27 ml/min, not to exceed a maximum dose of 2 vials per study subject per day or visit. The microvascular perfusion assessment using Definity be performed at rest as well as during slow and fast handgrip exercises.

  • MicroneurographyProcedure or surgery

    Also called Assessment of sympathetic nerve activity (SNA)

    Sympathetic nerve activity from the peroneal nerve measured by inserting a tiny needle directly into the nerve in the leg. Investigators will localize the nerve by electrical stimulation over the skin using a blunt probe. .The recording needle will remain in position throughout the study.

Study groups in NCT02102243
Study groupRoleWhat they receive
Hyperinsulinemic euglycemic clampExperimentalWe will perform following procedures: DEFINITY® infusion Flow mediated vasodilation Endothelial cell collection Microvascular perfusion assessment using Definity Microneurography
Receives: Drug: DEFINITY® infusion; Drug: Human Recombinant Regular Insulin infusion; Drug: Dextrose infusion; Procedure: Flow mediated vasodilation; Procedure: Endothelial cell collection; Procedure: Microvascular perfusion assessment using Definity; Procedure: Microneurography
Initial Saline InfusionExperimentalWe will perform the following procedures: DEFINITY® infusion Human Recombinant Regular Insulin infusion Dextrose infusion Flow mediated vasodilation Endothelial cell collection Microvascular perfusion assessment using Definity Microneurography
Receives: Drug: DEFINITY® infusion; Procedure: Flow mediated vasodilation; Procedure: Endothelial cell collection; Procedure: Microvascular perfusion assessment using Definity; Procedure: Microneurography

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Increase in muscle sympathetic nerve activity during hyperinsulinemic euglycemic clamp

    Measured: 1 day

Secondary outcomes (5)
  1. Change in microvascular blood flow during hyperinsulinemic euglycemic clamp.

    Measured: 1 day

  2. Change in microvascular blood flow during saline infusion.

    Measured: 1 day

  3. Change in endothelial cell protein expression after hyperinsulinemic euglycemic clamp

    Measured: 1 day

  4. Change in endothelial cell protein expression after saline infusion

    Measured: 1 day

  5. Increase in muscle sympathetic nerve activity during saline infusion

    Measured: 1 day

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Apr 2014 (estimated)
  2. Study startNov 2010
  3. Primary completionDec 2025 (estimated)
  4. Study completionDec 2025 (estimated)

Why it stopped: No longer interested in study topic

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Crossover
Masking
None (open label)
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02102243
Sponsor's protocol ID
STU 102010-063
Status last verified
Mar 2023
First submitted
6 Mar 2014
Last updated
15 Mar 2023
Results posted
No
Data monitoring committee
Yes

Publications

  • Catena C, Lapenna R, Baroselli S, Nadalini E, Colussi G, Novello M, Favret G, Melis A, Cavarape A, Sechi LA. Insulin sensitivity in patients with primary aldosteronism: a follow-up study. J Clin Endocrinol Metab. 2006 Sep;91(9):3457-63. doi: 10.1210/jc.2006-0736. Epub 2006 Jul 5.

    PubMed 16822818
  • Donato AJ, Gano LB, Eskurza I, Silver AE, Gates PE, Jablonski K, Seals DR. Vascular endothelial dysfunction with aging: endothelin-1 and endothelial nitric oxide synthase. Am J Physiol Heart Circ Physiol. 2009 Jul;297(1):H425-32. doi: 10.1152/ajpheart.00689.2008. Epub 2009 May 22.

    PubMed 19465546
  • Colussi G, Catena C, Lapenna R, Nadalini E, Chiuch A, Sechi LA. Insulin resistance and hyperinsulinemia are related to plasma aldosterone levels in hypertensive patients. Diabetes Care. 2007 Sep;30(9):2349-54. doi: 10.2337/dc07-0525. Epub 2007 Jun 15.

    PubMed 17575088
  • Kontak AC, Wang Z, Arbique D, Adams-Huet B, Auchus RJ, Nesbitt SD, Victor RG, Vongpatanasin W. Reversible sympathetic overactivity in hypertensive patients with primary aldosteronism. J Clin Endocrinol Metab. 2010 Oct;95(10):4756-61. doi: 10.1210/jc.2010-0823. Epub 2010 Jul 21.

    PubMed 20660053

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing DEFINITY® infusion, Human Recombinant Regular Insulin infusion and Dextrose infusion in people with Hypertension, run by Wanpen Vongpatanasin at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: withdrawn, as of the sponsor's last update on 15 Mar 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was withdrawn before enrolling participants, so there are no results.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Increase in muscle sympathetic nerve activity during hyperinsulinemic euglycemic clamp (time frame: 1 day). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02102243, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Mar 2023; AzTrials last refreshed its copy on 8 Nov 2026.

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