The EffecTs of Amlodipine and other Blood PREssure Lowering Agents on Microvascular FuncTion in Small Vessel Diseases (TREAT-SVDs) trial: Study protocol for a randomised crossover trial

Anna Kopczak, Michael S Stringer, Hilde van den Brink, Danielle Kerkhofs, Gordon W Blair, Maud van Dinther, Laurien Onkenhout, Karolina A Wartolowska, Michael J. Thrippleton, Marco Duering, Julie Staals, Martin Middeke, Elisabeth André, Bo Norrving, Marie Germaine Bousser, Ulrich Mansmann, Peter M. Rothwell, Fergus N Doubal, Robert van Oostenbrugge, Geert Jan BiesselsAlastair J.S. Webb, Joanna M. Wardlaw, Martin Dichgans*

*Corresponding author for this work

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Abstract

Background: Hypertension is the leading modifiable risk factor for cerebral small vessel diseases (SVDs). Yet, it is unknown whether antihypertensive drug classes differentially affect microvascular function in SVDs. Aims: To test whether amlodipine has a beneficial effect on microvascular function when compared to either losartan or atenolol, and whether losartan has a beneficial effect when compared to atenolol in patients with symptomatic SVDs. Design: TREAT-SVDs is an investigator-led, prospective, open-label, randomised crossover trial with blinded endpoint assessment (PROBE design) conducted at five study sites across Europe. Patients aged 18 years or older with symptomatic SVD who have an indication for antihypertensive treatment and are suffering from either sporadic SVD and a history of lacunar stroke or vascular cognitive impairment (group A) or CADASIL (group B) are randomly allocated 1:1:1 to one of three sequences of antihypertensive treatment. Patients stop their regular antihypertensive medication for a 2-week run-in period followed by 4-week periods of monotherapy with amlodipine, losartan and atenolol in random order as open-label medication in standard dose. Outcomes: The primary outcome measure is cerebrovascular reactivity (CVR) as determined by blood oxygen level dependent brain MRI signal response to hypercapnic challenge with change in CVR in normal appearing white matter as primary endpoint. Secondary outcome measures are mean systolic blood pressure (BP) and BP variability (BPv). Discussion: TREAT-SVDs will provide insights into the effects of different antihypertensive drugs on CVR, BP, and BPv in patients with symptomatic sporadic and hereditary SVDs. Funding: European Union’s Horizon 2020 programme. Trial registration: NCT03082014.

Original languageEnglish
Pages (from-to)387-397
Number of pages11
JournalEuropean Stroke Journal
Volume8
Issue number1
DOIs
Publication statusPublished - Mar 2023

Keywords

  • amlodipine
  • antihypertensive drug classes
  • blood pressure variability
  • CADASIL
  • cerebrovascular reactivity
  • lacunar stroke
  • magnetic resonance imaging
  • randomised clinical trial
  • Small vessel diseases
  • vascular cognitive impairment

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