RecruitingPhase 4NCT02817360

NT-proBNP Selected Prevention of Cardiac Events in Diabetic Patients

NT-proBNP Selected PreventiOn of Cardiac eveNts in a populaTion of dIabetic Patients Without A History of Cardiac Disease: a Prospective Randomized Trial


Sponsor

Martin Huelsmann

Enrollment

2,400 participants

Start Date

Feb 1, 2016

Study Type

INTERVENTIONAL

Conditions

Summary

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.


Eligibility

Min Age: 18 Years

Plain Language Summary

Simplified for easier understanding

This trial tests whether using a heart blood marker (NT-proBNP) to guide the use of heart-protecting medications can prevent heart problems in people with type 2 diabetes. You may be eligible if... - You have had type 2 diabetes for at least 6 months - You are 18 or older (men or women) - You are willing to participate and able to comply with study requirements You may NOT be eligible if... - You have a known allergy to the study medications or a history of intolerance to high-dose RAS-antagonists or beta-blockers - You are already on the maximum dose of a RAS-antagonist or beta-blocker - Your creatinine (kidney marker) is above 2.5 mg/dL - You have low blood pressure (systolic below 100 mmHg) or slow heart rate (below 60 bpm) - Your ECG or echocardiogram shows significant heart abnormalities (e.g., atrial fibrillation, low ejection fraction, significant valve problems) - You have coronary artery disease (e.g., prior heart attack, known coronary stenosis) - You have a life-limiting illness (less than 2 years expected survival) or active chronic infection or cancer Talk to your doctor to see if this trial is right for you.

This summary was AI-generated to explain the trial in plain language. It is not medical advice. Always discuss eligibility with your doctor before enrolling in a clinical trial.

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Interventions

DRUGRAS-antagonist and beta-blocker up-to maximal dosages

All patients have to be stable on their glucose lowering, lipid lowering and blood pressure lowering therapy at least for 3 months. RAS-antagonist and beta-blocker therapy at entrance is allowed. Patients receive a prescription and/or up-titration to maximum recommended or tolerated dose of RAS-antagonist and beta-blockers within three months of study entry. The Number of titration visits is up to the treating physician, but one visit should be performed at least at the end of titration.

OTHERRAS-antagonist and beta-blocker none or at stable dose

All patients have to be stable on their glucose lowering, lipid lowering and blood pressure lowering therapy at least for 3 months. RAS-antagonist and beta-blocker therapy at entrance is allowed. Changes in RAS-antagonist or beta-blocker therapy are not allowed in the control group during the study phase. If there is a vital indication for changes, this has to be argued and documented.


Locations(21)

Internistische Ordination

Mödling, Lower Austria, Austria

Klinischen Abteilung für Endokrinologie und Diabetologie MU Graz

Graz, Styria, Austria

Konventhospital der Barmherzigen Brüder Abteilung für Innere Medizin

Linz, Upper Austria, Austria

Krankenanstalt Rudolfstiftung, 1. Medizinische Abteilung

Vienna, Austria

Zentrum für Klinische Studien

Vienna, Austria

Medical University of Vienna Univ.Clinic for Internal Medicine II Department of Cardiology

Vienna, Austria

Univ. Klinik für Innere Medizin III Med. Uni Wien

Vienna, Austria

Universitätsklinik für Augenheilkunde und Optometrie Medizinische Universität Wien

Vienna, Austria

Diabetes & Stoffwechselambulanz Gesundheitszentrum Wien Süd

Vienna, Austria

3. Med. Abtlg., KH Hietzing mit Neurologischem Zentrum Rosenhügel

Vienna, Austria

iMED19

Vienna, Austria

Maastricht University Medical Center; Dep. Cardiology

Maastricht, Netherlands

Christchurch Heart Institute

Christchurch, New Zealand

Hospital de la Santa Creu i Sant Pau, Unitat de Diabetis, Servei d'Endocrinologia i Nutrició, Universitat Autònoma de Barcelona

Barcelona, Spain

Hospital Universitari Germans Trias i Pujol, l'Institut del Cor

Barcelona, Spain

Ninewells Hospital, Diabetes Support Unit

Dundee, United Kingdom

Queen Elisabeth University Hospital, Glasgow Clinical Research Facility

Glasgow, United Kingdom

North Manchester General Hospital, Diabetes centre

Manchester, United Kingdom

Nethergreen Surgery

Sheffield, United Kingdom

Ecclesfield Group Practice

Sheffield, United Kingdom

Woodseats Medical Centre

Sheffield, United Kingdom

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NCT02817360


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