Recruiting

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

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).

ClinicalTrials.gov IDNCT05593055
PhasePHASE4
Enrollment75
SponsorBrigham and Women's Hospital
Age18 Years
SexALL
I'm interested View official listing

Conditions studied

Hypertension, Left Ventricular Hypertrophy

About this study

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).

Interventions

Primary outcomes

Eligibility information

Inclusion 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: interventricular septum thickness ≥ 12mm 2. For women: interventricular septum thickness ≥ 11mm 3. We will also allow inclusion of people with treated hypothyroidism, pre-diabetes and diabetes controlled by diet, exercise, and/or metformin. Exclusion Criteria: * 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 \>75 years will be excluded due to safety concerns of administering an angiotensin-II infusion in these patient groups.

Study locations

Before you participate: Varda Clinical is an independent discovery tool, not the study sponsor or a medical provider. Eligibility can only be determined by the official study team. Discuss potential risks and benefits with a qualified healthcare professional.

Source: ClinicalTrials.gov. Record last refreshed by Varda Clinical: 2026-09-27.