Studying the Effects of Antihypertensives on Individuals at Risk for Alzheimer's
| Status: | Completed |
|---|---|
| Conditions: | Alzheimer Disease, High Blood Pressure (Hypertension) |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Neurology |
| Healthy: | No |
| Age Range: | 40 - 65 |
| Updated: | 3/30/2017 |
| Start Date: | April 2009 |
| End Date: | July 2011 |
Angiotensin converting enzyme inhibitors (ACE-I) are a group of blood pressure-lowering
medicines. Some studies suggest that ACE-I, such as ramipril, may help prevent Alzheimer's
disease (AD). The purpose of the research is to see how ramipril affects a substance in the
body called beta-amyloid. Beta-amyloid is found in the brain and in the liquid around the
brain and spinal cord. High amounts of beta-amyloid may be associated with a greater risk of
getting Alzheimer's disease. This study will see if ramipril can lower the amount of
beta-amyloid in the spinal fluid. This study will also see if ramipril affects blood vessel
function and memory and thinking. The investigators hope that future studies will show
whether ramipril might prevent memory loss and decrease the chance of developing Alzheimer's
disease.
medicines. Some studies suggest that ACE-I, such as ramipril, may help prevent Alzheimer's
disease (AD). The purpose of the research is to see how ramipril affects a substance in the
body called beta-amyloid. Beta-amyloid is found in the brain and in the liquid around the
brain and spinal cord. High amounts of beta-amyloid may be associated with a greater risk of
getting Alzheimer's disease. This study will see if ramipril can lower the amount of
beta-amyloid in the spinal fluid. This study will also see if ramipril affects blood vessel
function and memory and thinking. The investigators hope that future studies will show
whether ramipril might prevent memory loss and decrease the chance of developing Alzheimer's
disease.
High blood pressure (BP) in midlife is predictive of Alzheimer's disease (AD) in later life.
Similarly, reductions in BP are associated with protection against AD. Treatment with
antihypertensive medications, specifically angiotensin converting enzyme inhibitors (ACE-I)
such as ramipril, is associated with up to a 55% reduction in the prevalence of AD,
suggesting a potentially promising role for ACE-I in the prevention of AD. It is unknown
however 1) whether ACE-Is will have the same effect on CSF Aβ levels in humans as in animal
models 2) whether ACE-Is induce changes associated with vascular function (i.e. levels of
CSF angiotensin converting enzyme (ACE) and peripheral endothelial function) and 3) whether
there are interactions between ACE-I-induced changes in CSF Aβ, CSF ACE and indices of
vascular function.
One mechanism by which antihypertensives may protect against AD is via Aβ neuropathology. In
order to better understand the mechanisms through which ACE-I may modify CSF Aβ and possibly
AD risk, we propose a randomized, double-blind, placebo-controlled pilot clinical trial,
enrolling 20 middle-aged (age range 40 - 65 years), mildly hypertensive (between 130 - 160
mmHg mean systolic and between 85 - 100 mmHg mean diastolic) participants, who are adult
children of an individual with AD. The main objective of this trial is to examine the
effects of the ACE-I, ramipril, on 1) CSF Aβ levels 2) CSF ACE levels and 3) peripheral
endothelial function as measured by brachial artery flow-mediated vasodilation (FMD) and
aortic augmentation index (AAIx), in middle-aged adults with mildly elevated BP, who are at
increased risk of developing AD.
Similarly, reductions in BP are associated with protection against AD. Treatment with
antihypertensive medications, specifically angiotensin converting enzyme inhibitors (ACE-I)
such as ramipril, is associated with up to a 55% reduction in the prevalence of AD,
suggesting a potentially promising role for ACE-I in the prevention of AD. It is unknown
however 1) whether ACE-Is will have the same effect on CSF Aβ levels in humans as in animal
models 2) whether ACE-Is induce changes associated with vascular function (i.e. levels of
CSF angiotensin converting enzyme (ACE) and peripheral endothelial function) and 3) whether
there are interactions between ACE-I-induced changes in CSF Aβ, CSF ACE and indices of
vascular function.
One mechanism by which antihypertensives may protect against AD is via Aβ neuropathology. In
order to better understand the mechanisms through which ACE-I may modify CSF Aβ and possibly
AD risk, we propose a randomized, double-blind, placebo-controlled pilot clinical trial,
enrolling 20 middle-aged (age range 40 - 65 years), mildly hypertensive (between 130 - 160
mmHg mean systolic and between 85 - 100 mmHg mean diastolic) participants, who are adult
children of an individual with AD. The main objective of this trial is to examine the
effects of the ACE-I, ramipril, on 1) CSF Aβ levels 2) CSF ACE levels and 3) peripheral
endothelial function as measured by brachial artery flow-mediated vasodilation (FMD) and
aortic augmentation index (AAIx), in middle-aged adults with mildly elevated BP, who are at
increased risk of developing AD.
Inclusion Criteria:
- Between the ages of 40 and 65
- Mean resting blood pressure between 130-160 systolic and 85-100 diastolic
- Parent with Alzheimer's Disease
Exclusion Criteria:
- Current involvement in another investigational drug trial.
- Potassium > 5.0
- Dementia based on DSMIV criteria
- MMSE < 27
- Current blood pressure medication (< 4 months from screening)
- Weight loss medication
- Contraindications for LP
- Know diagnosis or history of hospitalization due to congestive heart failure
- Elevated creatinine (females > 1.3 mg/dL or males > 1.4 mg/dL at baseline)
- Diabetes Type I and II
- Know adverse reaction to an ACE-I or an angiotensin receptor blocker
- Pregnant of nursing women
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