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Trial registered on ANZCTR
Registration number
ACTRN12613001021763
Ethics application status
Approved
Date submitted
11/09/2013
Date registered
13/09/2013
Date last updated
6/08/2019
Date data sharing statement initially provided
6/08/2019
Type of registration
Retrospectively registered
Titles & IDs
Public title
Treatment of disordered blood pressure in spinal cord injury
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Scientific title
A double-blind, placebo controlled, crossover study of a nocturnal dose of captopril to determine its effect on diurnal blood pressure and orthostatic symptoms in people with spinal cord injury
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Secondary ID [1]
283186
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Nil
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Universal Trial Number (UTN)
U1111-1147-8242
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Orthostatic intolerance
290044
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Hypotension
290045
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Diurnal blood pressure
290046
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Nocturnal polyuria
290047
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Spinal cord injury
290048
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Condition category
Condition code
Cardiovascular
290423
290423
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0
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Other cardiovascular diseases
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Neurological
290424
290424
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0
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Other neurological disorders
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Injuries and Accidents
290455
290455
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0
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Other injuries and accidents
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Captopril, orally, nightly, starting at 25mg and uptitrating by 25mg a week to a maximum of 100mg over a 4 week titration phase, followed by maintenance phase for 4 weeks at the highest dose reached. Unused capsules to be returned at the end of each treatment arm. Washout period of 2 weeks between treatment arms.
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Intervention code [1]
287913
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Treatment: Drugs
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Comparator / control treatment
Placebo - microcellulose capsule
Placebo and captopril capsules are packaged to look identical
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Mean daytime blood pressure - measured by ambulatory blood pressure monitoring
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Assessment method [1]
290449
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Timepoint [1]
290449
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Before and after each treatment arm
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Secondary outcome [1]
304545
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Degree of nocturnal dipping - ratio of mean night:day systolic blood pressure as measured by ambulatory blood pressure monitoring
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Assessment method [1]
304545
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Timepoint [1]
304545
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Before and after each treatment arm
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Secondary outcome [2]
304546
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Orthostatic hypotension questionnaire symptom scale
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Assessment method [2]
304546
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Timepoint [2]
304546
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Before and after each treatment arm
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Secondary outcome [3]
304547
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Nocturnal urine production - volume of urine produced overnight expressed as a percentage of the entire day's urine volume; calculated from a diary kept over 3 consecutive days
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Assessment method [3]
304547
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Timepoint [3]
304547
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Before and after each treatment arm
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Eligibility
Key inclusion criteria
Traumatic spinal cord injury
Age 18 years or greater
Able to provide informed consent
Symptoms of orthostatic intolerance
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Known hypersensitivity to captopril or any other ACE inhibitor
Significant renal impairment
Persistent hyperkalaemia
Recent changes or titration of antihypertensive agents or intention to do so within duration of study
Presence of any other significant medical conditions likely to influence ability to co-operate or prevent adherence to protocol, or where treatment with captopril would put the participant at increased risk of adverse events or drug interactions
Pregnancy or breastfeeding
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Enrolled participants are allocated sequential randomisation numbers, where the randomisation schedule is held by the Department of Pharmacy, hence the investigators, assessors and participants remain blinded to treatment allocation.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Block randomisation
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
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Intervention assignment
Crossover
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Other design features
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Phase
Phase 4
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
The sample demographics, blood pressure and symptom scores will be described using descriptive and summary statistics. Comparisons of symptoms, blood pressure, autonomic function and urine measures between the treatment and placebo groups will be made using parametric (e.g. paired t-tests) or repeated measures analysis of variance as appropriate. Blood pressure will also be plotted across assessment points. Blood pressure, autonomic functioning and urine measures will be correlated with symptoms.
Assuming a total of 25 patients enter this two-treatment crossover study, the probability is 80 percent that the study will detect a treatment difference at a two-sided 0.05 significance level, if the true difference between treatments is 10 mmHg. This is based on the assumption that the within-patient standard deviation of the systolic blood pressure is 12 mmHg.
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Recruitment
Recruitment status
Stopped early
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Data analysis
No data analysis planned
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Reason for early stopping/withdrawal
Participant recruitment difficulties
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Date of first participant enrolment
Anticipated
9/08/2013
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Actual
9/08/2013
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Date of last participant enrolment
Anticipated
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Actual
5/12/2013
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Date of last data collection
Anticipated
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Actual
22/03/2014
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Sample size
Target
25
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Accrual to date
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Final
4
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
1500
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Austin Health - Austin Hospital - Heidelberg
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Funding & Sponsors
Funding source category [1]
287936
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Charities/Societies/Foundations
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Name [1]
287936
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Transport Accident Commission
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Address [1]
287936
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Level 6, 60 Brougham Street
Geelong, VIC 3220
Australia
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Country [1]
287936
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Australia
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Primary sponsor type
Hospital
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Name
Austin Hospital
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Address
Austin Hospital
145 Studley Road
Heidelberg Vic 3084
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Country
Australia
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Secondary sponsor category [1]
286663
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None
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Name [1]
286663
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Address [1]
286663
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Country [1]
286663
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
289864
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Austin Health Human Research Ethics Committee
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Ethics committee address [1]
289864
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Office for Research, Austin LifeSciences Austin Health PO Box 5555 Heidelberg Victoria Australia, 3084
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Ethics committee country [1]
289864
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Australia
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Date submitted for ethics approval [1]
289864
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22/02/2013
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Approval date [1]
289864
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02/05/2013
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Ethics approval number [1]
289864
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H2013 / 04981
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Summary
Brief summary
Spinal cord injury (SCI) results in permanent paralysis and significant disability. In addition, some spinal cord injured people experience postural hypotension, a large drop in blood pressure when assuming the upright position, associated with dizziness and fainting. For someone with SCI who is wheelchair dependent, fainting can have significant consequences such as further injury from falling out of the chair, reduced independence and limited vocational outcomes, thus poorer overall physical and psychological well-being. In SCI, interruption of nervous communications, along with the loss of muscle pump in the legs, results in the impaired ability to maintain blood pressure on getting upright. Such persons have an abnormal pattern of blood pressure, whereby the blood pressure does not drop overnight, unlike the usual pattern. In some cases, there is even a higher blood pressure during the night than during the day – opposite to the normal pattern. Higher night time blood pressure leads to increased night time urine production, leaving the body with relatively less circulating blood volume in the morning, at the time that one is about to get out of bed, further contributing to postural hypotension. This study aims to examine the effects of treatment with captopril, a blood pressure lowering medication, at night, in a person with SCI who experiences symptoms of postural hypotension; we hypothesise that lowering night time blood pressure will reduce night time urine production, therefore increase blood pressure during the day, and reduce symptoms of postural hypotension, allowing the ability to stay upright during the day to carry out activities. In this placebo controlled crossover study, participants will receive either the drug treatment or a placebo (dummy pill) for 8 weeks, and then switch to the other pill to determine if there is a difference in effects between the two. Each treatment period will be separated by two weeks where the participant is not on either pill. Before and after each treatment, assessments include: measurements of blood pressure profile over 24 hours using an automatic portable monitor, recording urine volumes for 4 days, analysis of urine and blood samples. Current treatment for such blood pressure disturbances and symptoms of low blood pressure are inadequate, and this study will help to determine whether this novel treatment is effective.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
42826
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Dr Christopher O'Callaghan
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Address
42826
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Department of Clinical Pharmacology
Harold Stokes Building Level 5
Austin Hospital
145 Studley Road
PO Box 5555
Heidelberg Vic 3084
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Country
42826
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Australia
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Phone
42826
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61 3 9496 5029
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Fax
42826
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61 3 9496 3221
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Email
42826
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christopher.o'
[email protected]
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Contact person for public queries
Name
42827
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Melinda Millard
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Address
42827
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Victorian Spinal Cord Service
Harold Stokes Building Level 8
Austin Hospital
145 Studley Road
PO Box 5555
Heidelberg Vic 3084
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Country
42827
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Australia
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Phone
42827
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61 3 9496 5906
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Fax
42827
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Email
42827
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[email protected]
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Contact person for scientific queries
Name
42828
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Min Yin Goh
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Address
42828
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Department of Clinical Pharmacology
Harold Stokes Building Level 5
Austin Hospital
145 Studley Road
PO Box 5555
Heidelberg Vic 3084
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Country
42828
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Australia
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Phone
42828
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61 3 9496 5029
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Fax
42828
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61 3 9496 3221
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Email
42828
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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