Efficacy and Safety of Qishen Yiqi Dropping Pills in Patients With Severe Pulmonary Hypertension
Efficacy and Safety of Qishen Yiqi Dropping Pills in Patients With Severe Pulmonary Hypertension: A Prospective, Randomized Controlled Trial
Guangdong Provincial People's Hospital
120 participants
Oct 25, 2023
INTERVENTIONAL
Conditions
Summary
This study aims to compare the effectiveness and safety of two treatment approaches for patients with severe pulmonary hypertension: standard targeted drug therapy alone, and a combination of standard targeted drugs plus Qishen Yiqi Dropping Pills over 52 weeks of treatment. Pulmonary hypertension is a chronic condition that raises blood pressure in the lung arteries, causing symptoms like shortness of breath, tiredness, and difficulty with physical activity. While targeted drug treatments are available, many patients still experience persistent symptoms and reduced quality of life. This study will enroll patients with severe pulmonary hypertension to see if adding Qishen Yiqi Dropping Pills to standard treatment can improve patient outcomes. Participants will be randomly assigned to one of two groups: the combination treatment group will receive Qishen Yiqi Dropping Pills plus standard targeted drugs, and the control group will receive standard targeted drugs alone. All participants will be followed for 52 weeks, during which we will regularly assess: * Changes in daily quality of life * How far participants can walk in 6 minutes, and their level of breathlessness after the walk * Changes in heart function and related blood test indicators * Any side effects or discomfort during treatment The primary goal of this study is to see if the combination treatment can improve patients' exercise capacity and quality of life more effectively than standard treatment alone. We will also monitor the safety of adding Qishen Yiqi Dropping Pills to standard therapy. All study procedures follow ethical regulations, and participants can withdraw from the study at any time without affecting their regular medical care.
Eligibility
Inclusion Criteria8
- \. Male or female participants aged between 18 and 75 years (inclusive) at the screening visit.
- \. Diagnosed with pulmonary arterial hypertension (PAH) classified according to the *2021 Chinese Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension*, and belonging to one of the following subgroups:
- Subgroup Ⅰ: Idiopathic pulmonary arterial hypertension (IPAH) under the category of arterial pulmonary hypertension
- Subgroup Ⅱ: Pulmonary hypertension secondary to left heart disease (congenital heart disease) 3. World Health Organization (WHO) Functional Class III or IV symptoms at screening.
- \. Meet all of the following hemodynamic criteria confirmed by right heart catheterization (RHC) at study screening: mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg and pulmonary capillary wedge pressure (PCWP) ≤ 15 mmHg.
- \. Able to walk a minimum of 100 meters and a maximum of 440 meters during the 6-Minute Walk Test (6MWT) at the screening visit; in addition, participants must demonstrate stable baseline 6MWT performance between the screening visit and the randomization visit.
- \. Participants with pulmonary hypertension who are either treatment-naïve or currently receiving treatment: for participants who have received prior treatment (defined as having used PAH-targeted therapeutic agents within 4 weeks before screening), mPAP ≥ 25 mmHg and PCWP ≤ 15 mmHg must be confirmed at the randomization visit.
- \. Able to understand study procedures, willing to comply with study restrictions, and willing and able to provide written informed consent prior to the initiation of all study-related procedures.
Exclusion Criteria23
- \. Meet any of the following criteria: 2. Diagnosed with Group 3 or Group 5 pulmonary hypertension (PH) according to the *2021 Chinese Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension*.
- \. Echocardiogram within 6 months before screening indicates left ventricular ejection fraction (LVEF) ≤ 40%, or clinically significant ischemic mitral or aortic valve disease, or constrictive heart disease as judged by the investigator.
- \. Presence of 3 or more of the following risk factors for left ventricular dysfunction:
- Body mass index (BMI) ≥ 30 kg/m² at screening visit
- History of essential hypertension
- Diabetes mellitus of any type
- History of significant coronary artery disease (CAD) confirmed by any of the following:
- History of myocardial infarction
- History of percutaneous coronary intervention (PCI)
- Angiographic evidence of ≥ 50% stenosis in at least one major coronary artery
- Positive cardiac stress imaging test
- History of coronary artery bypass graft surgery (CABG)
- History of chronic stable angina or unstable angina 5. Uncontrolled systemic arterial hypertension: systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg at randomization visit (Day 1).
- \. History of long QT syndrome or torsades de pointes ventricular tachycardia. 7. Serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥ 3 times the upper limit of normal (ULN) at screening visit.
- \. Severe renal impairment: estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m² at screening calculated by the CKD-EPI formula.
- \. Severe hepatic impairment (Child-Pugh Class C) at screening visit, with or without cirrhosis; patients receiving renal dialysis or with a history of renal transplantation.
- \. Known coagulation defects, including: hereditary or acquired coagulation disorders (factor XII deficiency, factor XIII deficiency), reduced coagulation factor production due to acute or chronic liver disease, impaired coagulation efficiency caused by lupus anticoagulant, disseminated intravascular coagulation (DIC), or anticoagulant factor autoantibodies.
- \. Evidence or history of major hemorrhage or intracranial hemorrhage. 12. History of increased intracranial pressure. 13. Pregnant or lactating women. 14. Any surgical or medical condition that may significantly alter the absorption, distribution, metabolism, or excretion of any drug, including but not limited to: history of major gastrointestinal surgery deemed clinically significant by the investigator within 12 months before screening (e.g., gastrectomy, gastrointestinal stoma anastomosis, intestinal resection, gastric bypass surgery, gastroenterostomy, or gastric banding), current active inflammatory bowel disease, or history of active inflammatory bowel disease.
- \. Any surgical or medical condition not specified in the protocol that, in the investigator's opinion, would expose the patient to higher risk due to study participation, or may prevent the patient from complying with study requirements or completing the trial period.
- \. Patients who are unwilling or unable to safely discontinue current pulmonary arterial hypertension (PAH)-targeted medications during the study as required by the protocol.
- \. History of any contraindication or hypersensitivity reaction to any study drug or drugs with similar chemical structures.
- \. History of active substance abuse (including alcohol) within the past 1 year, or patients considered potentially unreliable by the investigator.
- \. Personnel directly involved in the conduct of this clinical study.
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Interventions
Experimental Group: Qishen Yiqi Dropping Pills combined with standard PAH-targeted therapy. Qishen Yiqi Dropping Pills is an NMPA-approved Chinese patent medicine for cardiovascular diseases, each pill is 0.5g, main ingredients include astragalus membranaceus, salvia miltiorrhiza, panax notoginseng and dalbergia odorifera. Administration: 0.5g orally tid after meals. Targeted therapy follows \*2021 Chinese PAH Diagnosis and Treatment Guidelines\*, including one or more approved PAH-targeted agents at clinically recommended doses. Total treatment duration: 26weeks.
Control Group Intervention: Participants in this group receive standard pulmonary arterial hypertension (PAH)-targeted therapy alone, without additional Qishen Yiqi Dropping Pills. The targeted therapy regimen complies with the \*2021 Chinese Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension\*, including one or more clinically approved PAH-targeted agents (endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, or soluble guanylate cyclase stimulators) at standard recommended doses. The regimen is consistent with the participants' stable pre-enrollment treatment plan, or initiated per the protocol-specified dosing schedule, with no dose adjustment allowed during the study period unless required for safety reasons. The total treatment duration is 26 weeks, identical to the experimental group.
Locations(1)
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NCT07604805