Hypertension Clinical Trial
Official title:
Pilot Study of Aprepitant Effect on Aldosterone Secretion in Diabetic Patient (Diabetes Mellitus) With Hypertension Associated With Low Renin
Aldosterone regulation is mediated by hormonal control, and nervous control. Autonomic
nervous system action could be mediated by neuropeptides in the adrenal gland. Therefore, in
pathological conditions and especially in diabetes, low-renin hypertension with normal or
high plasma aldosterone could be caused by sympathetic nervous system hypertonia.
Data from the literature and previous in vitro research conducted in the investigators'
laboratory (INSERM U982, University of Rouen) suggest that adrenal corticosteroid secretion
might be controlled by sympathetic nervous system. This neurocrine regulation of
corticosteroid secretion involves locally released neuropeptides. Among them, substance P is
able to stimulate aldosterone and cortisol production via NK1 receptors. A previous clinical
trial conducted at the University Hospital of Rouen, APHOS (NCT00977223) studied the effects
of a NK1 receptor antagonist, aprepitant, on adrenocortical secretions in healthy volunteers.
The aim of the present study is to investigate the effects of a NK1 receptor antagonist,
aprepitant, on adrenocortical secretions in volunteers with diabetes associated with
low-renin hypertension. Aprepitant is a drug already available for the treatment of nausea
induced by chemotherapy.
In the present phase II trial, plasma aldosterone and cortisol levels will be measured under
treatment with aprepitant versus placebo, in both basal conditions and after activation of
the adrenocortical function by upright posture. All volunteers will be given the two
substances (aprepitant and placebo) in a random order during two 14 day-periods separated by
a 21 day-wash-out.
This study should allow to determine the role of substance P in the control of corticosteroid
production in human with diabetes, associated with a low-renin hypertension.
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