Mineralocorticoid Receptor, Coronary Microvascular Function, and Cardiac Efficiency in Hypertension

Description

The investigators' goal is to show that in hypertensive men and women with left ventricular hypertrophy (LVH) treatment with a mineralocorticoid receptor (MR) antagonist, versus a thiazide-like diuretic, will improve coronary microvascular function and cardiac efficiency, which will associate with improvements in LV structure and function. The investigators will achieve this through a randomized, controlled, basic experimental study involving humans (BESH).

Conditions

Hypertension, Left Ventricular Hypertrophy

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Study Overview

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Study Details

Study overview

The investigators' goal is to show that in hypertensive men and women with left ventricular hypertrophy (LVH) treatment with a mineralocorticoid receptor (MR) antagonist, versus a thiazide-like diuretic, will improve coronary microvascular function and cardiac efficiency, which will associate with improvements in LV structure and function. The investigators will achieve this through a randomized, controlled, basic experimental study involving humans (BESH).

Mineralocorticoid Receptor, Coronary Microvascular Function, and Cardiac Efficiency in Hypertension

Mineralocorticoid Receptor, Coronary Microvascular Function, and Cardiac Efficiency in Hypertension

Condition
Hypertension
Intervention / Treatment

-

Contacts and Locations

Boston

Brigham and Women's Hospital, Boston, Massachusetts, United States, 02115

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

For general information about clinical research, read Learn About Studies.

Eligibility Criteria

  • 1. History of hypertension
  • 1. Seated systolic BP \< 180 mmHg and diastolic \< 110 mmHg if on antihypertensives
  • 2. Seated systolic BP 141-200 mmHg and/or diastolic BP 90-114 mmHg if not on antihypertensives
  • 2. LVH by echocardiogram
  • 1. For men: LV mass index \> 134 g/m2
  • 2. For women: LV mass index \> 110 g/m2
  • 3. We will also allow inclusion of people with treated hypothyroidism, pre-diabetes and diabetes controlled by diet, exercise, and/or metformin.
  • * Use of MR antagonist (eplerenone, spironolactone, or finerenone) or amiloride (amiloride inhibits ENaC, which is a key mediator of MR's actions) within the past year
  • * Orthostatic hypotension
  • * Major medical illness, including uncontrolled diabetes mellitus (Hemoglobin A1c \>7.5)
  • * LV ejection fraction \< 40%
  • * New York Heart Association class III to IV congestive heart failure or unstable angina
  • * A history in the prior 6 months of Q-wave myocardial infarction, stroke, transient ischemic attack, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft
  • * History of secondary hypertension
  • * Known genetic cardiomyopathy
  • * Renal disease (seum creatinine \>1.5 mg/dL for men and \>1.3 mg/dL for women)
  • * Hepatic disease
  • * Bronchospastic lung disease
  • * Alcohol or substance abuse
  • * Hormone replacement therapy
  • * Abnormal values for electrolytes, liver enzymes or TSH
  • * Pregnancy or lactation
  • * All individuals \<18 and \>70 years will be excluded due to safety concerns of administering an angiotensin-II infusion in these patient groups.

Ages Eligible for Study

18 Years to 70 Years

Sexes Eligible for Study

ALL

Accepts Healthy Volunteers

No

Collaborators and Investigators

Brigham and Women's Hospital,

Gail K Adler, MD, PhD, PRINCIPAL_INVESTIGATOR, Brigham and Women's Hospital

Study Record Dates

2026-12-31