HypertensionPhase 4CSPPT2-TTNCT04974151
China Stroke Primary Prevention Trial 2 for Participants With Hypertension and MTHFR 677 TT Genotype
A Phase 4 study testing Amlodipine besylate, Amlodipine besylate And Folic Acid and 5-methyltetrahydrofolate (5-MTHF) in people with Hypertension and MTHFR 677 TT Genotype, run by Shenzhen Ausa Pharmed Co.,Ltd at 20 sites in China.
Trial summary
This is a multi-center, randomized, double-blind, triple-dummy, controlled trial in 24,000 Chinese men and women with hypertension and MTHFR 677 TT genotype. The study participants will be randomized to one of the three treatment groups: Group A: amlodipine tablet (5mg), taken orally, once daily, serving as active… Read more about this study
- Who is it for?
- Ages 45 to 74 years
- Conditions the study is for
- Hypertension, MTHFR 677 TT Genotype
- What is being tested?
- Amlodipine besylate, Amlodipine besylate And Folic Acid and 5-methyltetrahydrofolate (5-MTHF)
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 24,000 participants
- Where
- 20 sitesChina
- Study dates
- 22 Aug 2024to 30 Jun 2029
- Phase
- Phase 4
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 45 to 74 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Men and women, aged ≥45 and <75 years.
- Hypertension: Previously diagnosed with primary hypertension and has been taking antihypertensive medication within the past two weeks; OR has not been taking antihypertensive medications within the last two weeks, but meets the following criteria for hypertension: SBP≥140 mmHg and/or DBP≥90 mmHg (average of at least 2 measurements each time) at two separate (not on the same day) clinical visits.
- MTHFR 677 TT genotype (based on the test results from the central laboratory during the screening period or a previous official test report from a laboratory with medical testing qualifications).
- Voluntarily participates and has given signed informed consent.
- Randomized-treatment phase inclusion criteria:
- Good compliance during the run-in period, and unlikely to discontinue treatment;
- No stroke or cardiovascular events during the run-in period;
- The participant voluntarily agrees to continue the study.
Who cannot join
- Previously diagnosed secondary hypertension;
- Previously diagnosed stroke;
- Previously diagnosed myocardial infarction;
- Previously diagnosed heart failure;
- Previously diagnosed atrial fibrillation;
- Cardio-cerebral-kidney revascularization and/or other large arterial stent;
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- Currently on dialysis, or diagnosed with stage 4-5 chronic kidney disease, or eGFR <30 mL/ min/1.73m²;
- Known to have congenital (such as aortic stenosis) or acquired organic heart disease;
- Known to have any of the following severe diseases or conditions:
- Digestive system: i. Previously diagnosed with any form of viral hepatitis that is currently still in the active phase; ii. Abnormal liver function test before enrollment (any of ALT, AST, GGT, TBIL, DBIL test 3 times higher than normal, or ALB≤30g/L); iii. Subtotal gastrectomy and/or gastrojejunostomy;
- Respiratory system: previously diagnosed with pulmonary heart disease;
- Presence of malignant tumors or other severe diseases;
- Presence of long-term gastrointestinal symptoms such as ; anorexia, decreased appetite, nausea, and abdominal bloating;
- Previously diagnosed with vitamin B12 deficiency and/or its related diseases.
- Participant, at the investigator's discretion, is assessed to be unsuitable for the study, for reasons including but not limited to the presence of abnormal laboratory results, or clinical conditions;
- Prior history of significant intolerance due to adverse reactions resulting from usage of amlodipine or other CCBs, valsartan or other ARBs, indapamide or other similar diuretics, metoprolol tartaric acid or other beta-blockers, or any drugs or health products containing folate or folic acid;
- Regular consumption of folic acid or vitamin B compounds, or other compounds containing folic acid in the past 3 months;
- The presence of any of the following conditions that could negatively influence a participant's ability to consent or participate in the trial:
- Dementia;
- Severe mental disorders;
- Inability to express informed consent;
- Unlikely to complete the study follow-up as specified by the protocol, or plans to relocate outside of the study area in the near future;
- History of poor compliance when taking antihypertensive medications or is expected to have poor compliance during the study;
- Refusal to participate, or inability to modify current drug regimen;
- Women who are pregnant or breastfeeding; or subjects of childbearing potential who are unwilling or unable to use effective contraception during the study period.
- Within one month prior to the first visit, having participated in any clinical trial for a drug that has not yet been officially approved by the state or is not currently approved for sale; or currently participating in any clinical trial that could potentially impact the results of this study (medication use, drug efficacy, drug interaction, etc.).
Trial locations and contacts
20 sites in 1 country. Contact the study team or a site near you to ask about taking part.
20 sites in 1 country
China20 sites, 20 recruiting
- Not yet recruiting
Peking University First Hospital
Beijing, Beijing Municipality
Jianping Li, MD, PhD
Jianping Li, MD, PhD
- Not yet recruiting
First Affillated Hospital of Bengbu Medical University
Bengbu, Anhui, 233004
Hongju Wang, MD, 13955231336, 1649134019@qq.com
Hongju Wang, MD
- Not yet recruiting
Bozhou People's Hospital
Bozhou, Anhui
Rongyan Jiang
Rongyan Jiang, MD
- Not yet recruiting
Chengdu Fifth People's Hospital
Chengdu, Sichuan
Lihua Zhou, MD
Lihua Zhou, MD
- Not yet recruiting
Chizhou People's Hospital
Chizhou, Anhui
Xiaodong Xu, MD
Xiaodong Xu, MD
- Not yet recruiting
Deyang People's Hospital
Deyang, Sichuan
Yangyun Han, MD
Yangyun Han, MD
- Not yet recruiting
Taihe County People's Hospital
Fuyang, Anhui
Shuguang Zhao, MD
Shuguang Zhao, MD
- Not yet recruiting
The First Affiliated Hospital of Gannan Medical University
Ganzhou, Jiangxi
Guoxi Zhang, MD
Guoxi Zhang, MD
- Not yet recruiting
The Affiliated Hospital of Guizhou Medical University
Guiyang, Guizhou
Fang Wei
Wei Li, MD
- Not yet recruiting
The First Affiliated Hospital of Hunan University of Medicine
Huaihua, Hunan
Bifeng Tan
Bifeng Tan, MD
- Recruiting
Lianyungang Oriental Hospital
Lianyungang, Jiangsu, 222042
Yubao Wang, MD, 15261379656, wyb7509@163.com
Yubao Wang, MD
- Not yet recruiting
The First People's Hospital of Lianyungang
Lianyungang, Jiangsu
Hui Shi, MD
Hui Shi, MD
- Not yet recruiting
The Second People's Hospital of Lianyungang
Lianyungang, Jiangsu
Liming Sun, MD
Liming Sun, MD
- Not yet recruiting
Loudi Central Hospital
Loudi, Hunan
Weimin Hu, MD
Weimin Hu, MD
- Not yet recruiting
The Affiliated Hospital of Southwest Medical University
Luzhou, Sichuan
Juyi Wan
Juyi Wan, MD
- Not yet recruiting
Second Affiliated Hospital of Nanchang University
Nanchang, Jiangxi
Huihui Bao, MD
Huihui Bao, MD
- Not yet recruiting
Weinan Central Hospital
Weinan, Shaanxi
Junnong Li, MD
Junnong Li, MD
- Not yet recruiting
Yancheng First People's Hospital
Yancheng, Jiangsu
Qilong Zuo, MD
Qilong Zuo, MD
- Not yet recruiting
Yangjiang People's Hospital
Yangjiang, Guangdong
Qianqian Tan, MD
Qianqian Tan, MD
- Not yet recruiting
Tengzhou Central People's Hospital
Zaozhuang, Shandong, 277599
Yong Li, MD, 13563295777, tzlysd123@163.com
Yong Li, MD
About this study
Official title: Comparative Efficacy of Amlodipine Folic Acid vs. Amlodipine on the Risk of First Ischemic Stroke Among Participants With Hypertension and MTHFR 677 TT Genotype: A Multi-center, Randomized, Double-blind, Triple-dummy, Controlled Clinical Trial
This is a multi-center, randomized, double-blind, triple-dummy, controlled trial in 24,000 Chinese men and women with hypertension and MTHFR 677 TT genotype.
The study participants will be randomized to one of the three treatment groups:
Group A: amlodipine tablet (5mg), taken orally, once daily, serving as active comparator.
Group B: amlodipine folic acid 5.8mg tablet (5mg amlodipine and 0.8mg folic acid), taken orally, once daily.
Group C: amlodipine folic acid 5.8mg tablet plus 5-methyltetrahydrofolate (5-MTHF, 0.4mg), taken orally, once daily.
The primary endpoint is first ischemic stroke.
Read the detailed description
This study consists of 3 periods: Screening, Run-in, and Randomized treatment.
Period I: Screening (V0)
The purpose of Period I is to obtain informed consent and screen for eligible participants.
After obtaining written informed consent, at the screening visit (V0), participants will complete a face-to-face interview and clinical evaluation and measurements. Their biological samples will be collected for laboratory analyses. Collectively, these information will help to determine eligibility for inclusion in the study.
Period II: Run-in Period (VD)
The purpose of Run-in is to assess participants' compliance for following the amlodipine treatment regimen as well as to observe participants' tolerance to amlodipine, so as to screen out those with poor compliance or intolerance to amlodipine treatment.
The run-in phase lasted 2 to 4 weeks, during which oral administration of Amlodipine tablets (5 mg) was given once daily.
Period III: Randomized Treatment (V1-V21)
This is a 5-year period of randomized, double-blind, triple-dummy, controlled treatment. At each of the research centers, participants who remain eligible for participation in the study will be randomized into 3 treatment groups:
- Amlodipine-only (5mg/d) with an amlodipine folic acid placebo and 5-MTHF placebos.
- Amlodipine folic acid tablet (5.8mg/d) with amlodipine placebo and 5-MTHF placebo.
- Amlodipine folic acid tablets (5.8mg/d) and 5-MTHF (0.4mg/d) with an amlodipine placebo in a 1:1:1 ratio, using the randomization and trial supply management (RTSM) platform.
During the treatment period, other antihypertensive drugs can be added to achieve blood pressure control (BP ≤140/90mmHg), including Valsartan (80mg/d), or/and Indapamide (1.5mg/d), or/and metoprolol tartrate tablets (25mg/d). Participants will be followed up every 3 months during the treatment period, and the treatment drugs will be distributed at each visit.
A total of 24,000 participants will be randomly assigned to one of three treatment groups (Group A n=8,000, Group B n=8,000, Group C n=8,000). Based on published data from CSPPT (Huo et al, JAMA, 2015), the 5-year cumulative incidence of first ischemic stroke in the amlodipine-only group is 3.5%. Assuming the 5-year cumulative incidence of first ischemic stroke in the amlodipine-only group is around 3.5%, this trial has 80% power to detect a 20% difference between group A and group B+C in the observed hazard ratio (HR) for incident ischemic stroke (HR≤0.80), at a two-sided significance level of α=0.05. If instead, the 5-year incidence of ischemic stroke in the amlodipine-only group is 2.5%, this trial has 80% power to detect a 23% difference between the treatment groups (A vs B+C) (HR≤0.77).
There are two planned interim analyses, one at the end of the third year, and another at the end of the fourth year. The O'Brien-Fleming alpha-spending function will be used to define the significance level of each interim analysis to ensure that the final overall two-sided significance level of α=0.05 is met.
- Conditions
- Hypertension, MTHFR 677 TT Genotype
- Being tested
- Amlodipine besylate, Amlodipine besylate And Folic Acid, 5-methyltetrahydrofolate (5-MTHF), Amlodipine placebo, Amlodipine folic acid placebo
- Keywords
- Folic acid, Homocysteine, MTHFR 677 TT genotype, Randomized controlled trial, Ischemic stroke, 5-MTHF
- Medical subject headings
- Hypertension, Ischemic Stroke
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Amlodipine besylateDrug
Also called Amlodipine
The amlodipine used in this study is a listed product.
Amlodipine besylate And Folic AcidDrug
Also called Amlodipine Folic Acid, Anye
The amlodipine besylate and folic acid tablets have been approved for listing by the China Food and Drug Administration, approval number: Zhunzi H20180020.
5-methyltetrahydrofolate (5-MTHF)Drug
Also called 5-MTHF
The 5-MTHF used in this study is a listed product.
Amlodipine placeboDrug
Also called Amlodipine (dummy)
Amlodipine placebos are dummy pills of amlodipine with identical appearance.
Amlodipine folic acid placeboDrug
Also called Amlodipine folic acid (dummy)
Amlodipine folic acid placebos are dummy pills of amlodipine folic acid with identical appearance.
5-MTHF PlacebosDrug
Also called 5-MTHF (dummy)
5-MTHF placebos are the dummy pills of 5-MTHF with identical appearance.
| Study group | Role | What they receive |
|---|---|---|
| Amlodipine (5mg/d) | Active comparator | Amlodipine 5mg x1 tablet + Amlodipine folic acid (dummy) x1 tablet + 5-MTHF (dummy) x2 tablets, taken orally, in the morning after waking up.
Amlodipine tablets, amlodipine folic acid placebos, and 5-MTHF placebos are provided in aluminum-plastic blister plate. Each package includes 100 days of treatment drug (including 10 extra days of treatment for the follow-up window). A package of medication consists of 50 plates, each plate includes a total of 8 tablets arranged as follows: amlodipine 5mg x2 tablets + amlodipine folic acid (dummy) x2 tablets + 5-MTHF (dummy) x4 tablets. Affixed to the package is the randomized treatment drug label (400 tablets/package, 4 tablets/day). Receives: Drug: Amlodipine besylate; Drug: Amlodipine folic acid placebo; Drug: 5-MTHF Placebos |
| Amlodipine folic acid (5.8mg/d) | Experimental | Amlodipine folic acid 5.8mg x1 tablet + amlodipine (dummy) x1 tablet + 5-MTHF (dummy) x2 tablets, taken orally, in the morning after waking up.
Amlodipine folic acid tablets, amlodipine placebos, and 5-MTHF placebos are provided in aluminum-plastic blister plate. Each package includes 100 days of treatment drug (including 10 extra days of treatment for the follow-up window). A package of medication consists of 50 plates, each plate includes a total of 8 tablets arranged as follows: amlodipine folic acid 5.8mg x2 tablets + amlodipine (dummy) x2 tablets + 5-MTHF (dummy) x4 tablets. Affixed to the package is the randomized treatment drug label (400 tablets/package, 4 tablets/day). Receives: Drug: Amlodipine besylate And Folic Acid; Drug: Amlodipine placebo; Drug: 5-MTHF Placebos |
| Amlodipine folic acid (5.8mg/d) + 5-MTHF (0.4mg/d) | Experimental | Amlodipine folic acid 5.8mg x1 tablet + 5-methyltetrahydrofolate 0.2mg x2 tablets + amlodipine (dummy) x1 tablet, taken orally, in the morning after waking up.
Amlodipine folic acid tablets, 5-MTHF, and amlodipine placebos are provided in aluminum-plastic blister plate. Each package includes 100 days of treatment drug (including 10 extra days of treatment for the follow-up window). A package of medication consists of 50 plates, each plate includes a total of 8 tablets arranged as follows: amlodipine folic acid 5.8mg x2 tablets + amlodipine (dummy) x2 tablets + 5-MTHF, 0.2mg x4 tablets. Affixed to the package is the randomized treatment drug label (400 tablets/package, 4 tablets/day). Receives: Drug: Amlodipine besylate And Folic Acid; Drug: 5-methyltetrahydrofolate (5-MTHF); Drug: Amlodipine placebo |
What is being measured
The primary outcome is the main question the study is designed to answer.
First ischemic stroke
The primary aim of the trial is to determine whether amlodipine folic acid tablets (including Group B and Group C), compared to amlodipine alone (Group A), can further reduce the risk of first ischemic stroke among eligible participants with hypertension and the MTHFR 677 TT genotype.
Measured: By the end of the fifth year of the study
Secondary outcomes (8)
First ischemic stroke (for refined treatment group comparisons)
We will examine whether there exist significant differences in efficacy in reducing the risk of first ischemic stroke between the following pairs of treatment groups:
Group B vs. Group A
Group C vs. Group A
Group B vs. Group C
Measured: By the end of the fifth year of the study
First stroke (ischemic and hemorrhagic)
We will examine whether there exist significant differences in efficacy in reducing the risk of first stroke between the following pairs of treatment groups:
Groups B + C vs. Group A
Group B vs. Group A
Group C vs. Group A
Group B vs. Group C
Measured: By the end of the fifth year from baseline
Composite cardiovascular endpoint (first non-fatal stroke, first non-fatal myocardial infarction, cardiovascular death)
We will examine whether there exist significant differences in efficacy in reducing the risk of composite cardiovascular endpoint between the following pairs of treatment groups:
Groups B + C vs. Group A
Group B vs. Group A
Group C vs. Group A
Group B vs. Group C
Measured: By the end of the fifth year from baseline
Kidney outcomes
- The primary kidney outcome is composite kidney outcome, defined as: (1) a decrease in eGFR of 30% or more and to a level of less than 60 mL/min/1.73 m2 if the baseline eGFR is 60 mL/min/1.73 m2 or more, or (2) a decrease in eGFR of 50% or more if the baseline eGFR is less than 60 mL/min/1.73 m2, or (3) end-stage kidney disease (ESKD) (eGFR <15 mL/min/1.73m2 or dialysis or kidney transplantation).
- Secondary kidney outcomes: (1) eGFR decline ≥40% from baseline, or end-stage kidney disease; (2) annual rate of relative decline in eGFR; (3) Incidence of proteinuria, or progression of proteinuria.
We will examine whether there exist significant differences in treatment efficacy on the above kidney endpoints between the following pairs of treatment groups:
Groups B + C vs. Group A
Group B vs. Group A
Group C vs. Group A
Group B vs. Group C
Measured: By the end of the fifth year from baseline
First hemorrhagic stroke
We will examine whether amlodipine folic acid tablets (including Groups B and C), compared to amlodipine alone (Group A), show significantly greater efficacy in preventing first hemorrhagic stroke.
Measured: By the end of the fifth year from baseline
First myocardial infarction
We will examine whether amlodipine folic acid tablets (including Groups B and C), compared to amlodipine alone (Group A), show significantly greater efficacy in preventing first myocardial infarction.
Measured: By the end of the fifth year from baseline
First coronary revascularization (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI])
We will examine whether amlodipine folic acid tablets (including Groups B and C), compared to amlodipine alone (Group A), show significantly greater efficacy in preventing first coronary revascularization.
Measured: By the end of the fifth year from baseline
Cardiovascular death
We will examine whether amlodipine folic acid tablets (including Groups B and C), compared to amlodipine alone (Group A), show significantly greater efficacy in preventing cardiovascular death.
Measured: By the end of the fifth year from baseline
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted23 Jul 2021
- Study start22 Aug 2024
- Primary completion30 Jun 2029 (estimated)
- Study completion30 Jun 2029 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (12)Papers the sponsor has linked to this study.
- Other trials for HypertensionStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Multicenter, randomized, controlled, double-blind, triple-dummy clinical trial
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 24,000 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Shenzhen Ausa Pharmed Co.,Ltd
- Sponsor type
- Industry (pharma, biotech, devices)
- Collaborators
- Peking University First Hospital, Second Affiliated Hospital of Nanchang University, The First People's Hospital of Lianyungang, The Affiliated Hospital Of Guizhou Medical University, Lianyungang Oriental Hospital, Tengzhou Central People's Hospital, The First Affiliated Hospital of Bengbu Medical University, Shenzhen Prospective Medical Technology Co., LTD, Weinan Central Hospital, The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Loudi Central Hospital, Yancheng First People's Hospital, TAIHE country people's hospital, First Affiliated Hospital of Gannan Medical University, Yangjiang People's Hospital, Deyang People's Hospital, Bozhou people's hospital, Chizhou people's hospital, Lianyungang Second People's Hospital, The Affiliated Hospital Of Southwest Medical University, Chengdu Fifth People's Hospital
- Responsible party
- Sponsor
- Investigators
- Jianping Li, MD, PhD, Principal investigator, Peking University First Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04974151
- Sponsor's protocol ID
- CSPPT2-TT_2020
- Acronym
- CSPPT2-TT
- Status last verified
- Feb 2025
- First submitted
- 13 Jul 2021
- Last updated
- 26 Feb 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Kjeldsen SE, Julius S, Hedner T, Hansson L. Stroke is more common than myocardial infarction in hypertension: analysis based on 11 major randomized intervention trials. Blood Press. 2001;10(4):190-2. doi: 10.1080/08037050152669684. No abstract available.
PubMed 11800055Collaboration HLT. Lowering blood homocysteine with folic acid based supplements: meta-analysis of randomised trials. Homocysteine Lowering Trialists' Collaboration. BMJ. 1998 Mar 21;316(7135):894-8.
PubMed 9569395Homocysteine Lowering Trialists' Collaboration. Dose-dependent effects of folic acid on blood concentrations of homocysteine: a meta-analysis of the randomized trials. Am J Clin Nutr. 2005 Oct;82(4):806-12. doi: 10.1093/ajcn/82.4.806.
PubMed 16210710Wilcken B, Bamforth F, Li Z, Zhu H, Ritvanen A, Renlund M, Stoll C, Alembik Y, Dott B, Czeizel AE, Gelman-Kohan Z, Scarano G, Bianca S, Ettore G, Tenconi R, Bellato S, Scala I, Mutchinick OM, Lopez MA, de Walle H, Hofstra R, Joutchenko L, Kavteladze L, Bermejo E, Martinez-Frias ML, Gallagher M, Erickson JD, Vollset SE, Mastroiacovo P, Andria G, Botto LD. Geographical and ethnic variation of the 677C>T allele of 5,10 methylenetetrahydrofolate reductase (MTHFR): findings from over 7000 newborns from 16 areas world wide. J Med Genet. 2003 Aug;40(8):619-25. doi: 10.1136/jmg.40.8.619. No abstract available.
PubMed 12920077Xu X, Li J, Sheng W, Liu L. Meta-analysis of genetic studies from journals published in China of ischemic stroke in the Han Chinese population. Cerebrovasc Dis. 2008;26(1):48-62. doi: 10.1159/000135653. Epub 2008 May 30.
PubMed 18511872Qin X, Li J, Cui Y, Liu Z, Zhao Z, Ge J, Guan D, Hu J, Wang Y, Zhang F, Xu X, Wang X, Xu X, Huo Y. MTHFR C677T and MTR A2756G polymorphisms and the homocysteine lowering efficacy of different doses of folic acid in hypertensive Chinese adults. Nutr J. 2012 Jan 10;11:2. doi: 10.1186/1475-2891-11-2.
PubMed 22230384Qin X, Li J, Cui Y, Liu Z, Zhao Z, Ge J, Guan D, Hu J, Wang Y, Zhang F, Xu X, Wang X, Xu X, Huo Y. Effect of folic acid intervention on the change of serum folate level in hypertensive Chinese adults: do methylenetetrahydrofolate reductase and methionine synthase gene polymorphisms affect therapeutic responses? Pharmacogenet Genomics. 2012 Jun;22(6):421-8. doi: 10.1097/FPC.0b013e32834ac5e8.
PubMed 21869730Qin X, Li J, Zhang Y, Ma W, Fan F, Wang B, Xing H, Tang G, Wang X, Xu X, Xu X, Huo Y. Prevalence and associated factors of diabetes and impaired fasting glucose in Chinese hypertensive adults aged 45 to 75 years. PLoS One. 2012;7(8):e42538. doi: 10.1371/journal.pone.0042538. Epub 2012 Aug 3.
PubMed 22880024Dong Q, Tang G, He M, Cai Y, Cai Y, Xing H, Sun L, Li J, Zhang Y, Fan F, Wang B, Sun N, Liu L, Xu X, Hou F, Shen H, Xu X, Huo Y. Methylenetetrahydrofolate reductase C677T polymorphism is associated with estimated glomerular filtration rate in hypertensive Chinese males. BMC Med Genet. 2012 Aug 16;13:74. doi: 10.1186/1471-2350-13-74.
PubMed 22897803Huo Y, Li J, Qin X, Huang Y, Wang X, Gottesman RF, Tang G, Wang B, Chen D, He M, Fu J, Cai Y, Shi X, Zhang Y, Cui Y, Sun N, Li X, Cheng X, Wang J, Yang X, Yang T, Xiao C, Zhao G, Dong Q, Zhu D, Wang X, Ge J, Zhao L, Hu D, Liu L, Hou FF; CSPPT Investigators. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. JAMA. 2015 Apr 7;313(13):1325-35. doi: 10.1001/jama.2015.2274.
PubMed 25771069Huang X, Li Y, Li P, Li J, Bao H, Zhang Y, Wang B, Sun N, Wang J, He M, Yin D, Tang G, Chen Y, Cui Y, Huang Y, Hou FF, Qin X, Huo Y, Cheng X. Association between percent decline in serum total homocysteine and risk of first stroke. Neurology. 2017 Nov 14;89(20):2101-2107. doi: 10.1212/WNL.0000000000004648. Epub 2017 Oct 13.
PubMed 29030456Qin X, Li Y, Sun N, Wang H, Zhang Y, Wang J, Li J, Xu X, Liang M, Nie J, Wang B, Cheng X, Li N, Sun Y, Zhao L, Wang X, Hou FF, Huo Y. Elevated Homocysteine Concentrations Decrease the Antihypertensive Effect of Angiotensin-Converting Enzyme Inhibitors in Hypertensive Patients. Arterioscler Thromb Vasc Biol. 2017 Jan;37(1):166-172. doi: 10.1161/ATVBAHA.116.308515. Epub 2016 Nov 10.
PubMed 27834686
Study at a glance
From the registry record, last updated by the sponsor on 26 Feb 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparative Efficacy of Amlodipine Folic Acid vs. Amlodipine on the Risk of First Ischemic Stroke Among Participants With Hypertension and MTHFR 677 TT Genotype: A Multi-center, Randomized, Double-blind, Triple-dummy, Controlled Clinical Trial
- ClinicalTrials.gov ID
- NCT04974151
- Acronym / sponsor ID
- CSPPT2-TT / CSPPT2-TT_2020
- Conditions
- Hypertension, MTHFR 677 TT Genotype
- Keywords
- Folic acid, Homocysteine, MTHFR 677 TT genotype, Randomized controlled trial, Ischemic stroke, 5-MTHF
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 24,000 participants (estimated)
- Lead sponsor
- Shenzhen Ausa Pharmed Co.,LtdIndustry (pharma, biotech, devices)
- Collaborators
- Peking University First Hospital, Second Affiliated Hospital of Nanchang University, The First People's Hospital of Lianyungang, The Affiliated Hospital Of Guizhou Medical University, Lianyungang Oriental Hospital, Tengzhou Central People's Hospital, The First Affiliated Hospital of Bengbu Medical University, Shenzhen Prospective Medical Technology Co., LTD, Weinan Central Hospital, The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Loudi Central Hospital, Yancheng First People's Hospital, TAIHE country people's hospital, First Affiliated Hospital of Gannan Medical University, Yangjiang People's Hospital, Deyang People's Hospital, Bozhou people's hospital, Chizhou people's hospital, Lianyungang Second People's Hospital, The Affiliated Hospital Of Southwest Medical University, Chengdu Fifth People's Hospital
- Study start
- 22 Aug 2024 (actual)
- Primary completion
- 30 Jun 2029 (estimated)
- Study completion
- 30 Jun 2029 (estimated)
- First posted
- 23 Jul 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This is a multi-center, randomized, double-blind, triple-dummy, controlled trial in 24,000 Chinese men and women with hypertension and MTHFR 677 TT genotype.
The study participants will be randomized to one of the three treatment groups:
Group A: amlodipine tablet (5mg), taken orally, once daily, serving as active comparator.
Group B: amlodipine folic acid 5.8mg tablet (5mg amlodipine and 0.8mg folic acid), taken orally, once daily.
Group C: amlodipine folic acid 5.8mg tablet plus 5-methyltetrahydrofolate (5-MTHF, 0.4mg), taken orally, once daily.
The primary endpoint is first ischemic stroke.
Detailed description
This study consists of 3 periods: Screening, Run-in, and Randomized treatment.
Period I: Screening (V0)
The purpose of Period I is to obtain informed consent and screen for eligible participants.
After obtaining written informed consent, at the screening visit (V0), participants will complete a face-to-face interview and clinical evaluation and measurements. Their biological samples will be collected for laboratory analyses. Collectively, these information will help to determine eligibility for inclusion in the study.
Period II: Run-in Period (VD)
The purpose of Run-in is to assess participants' compliance for following the amlodipine treatment regimen as well as to observe participants' tolerance to amlodipine, so as to screen out those with poor compliance or intolerance to amlodipine treatment.
The run-in phase lasted 2 to 4 weeks, during which oral administration of Amlodipine tablets (5 mg) was given once daily.
Period III: Randomized Treatment (V1-V21)
This is a 5-year period of randomized, double-blind, triple-dummy, controlled treatment. At each of the research centers, participants who remain eligible for participation in the study will be randomized into 3 treatment groups:
- Amlodipine-only (5mg/d) with an amlodipine folic acid placebo and 5-MTHF placebos.
- Amlodipine folic acid tablet (5.8mg/d) with amlodipine placebo and 5-MTHF placebo.
- Amlodipine folic acid tablets (5.8mg/d) and 5-MTHF (0.4mg/d) with an amlodipine placebo in a 1:1:1 ratio, using the randomization and trial supply management (RTSM) platform.
During the treatment period, other antihypertensive drugs can be added to achieve blood pressure control (BP ≤140/90mmHg), including Valsartan (80mg/d), or/and Indapamide (1.5mg/d), or/and metoprolol tartrate tablets (25mg/d). Participants will be followed up every 3 months during the treatment period, and the treatment drugs will be distributed at each visit.
A total of 24,000 participants will be randomly assigned to one of three treatment groups (Group A n=8,000, Group B n=8,000, Group C n=8,000). Based on published data from CSPPT (Huo et al, JAMA, 2015), the 5-year cumulative incidence of first ischemic stroke in the amlodipine-only group is 3.5%. Assuming the 5-year cumulative incidence of first ischemic stroke in the amlodipine-only group is around 3.5%, this trial has 80% power to detect a 20% difference between group A and group B+C in the observed hazard ratio (HR) for incident ischemic stroke (HR≤0.80), at a two-sided significance level of α=0.05. If instead, the 5-year incidence of ischemic stroke in the amlodipine-only group is 2.5%, this trial has 80% power to detect a 23% difference between the treatment groups (A vs B+C) (HR≤0.77).
There are two planned interim analyses, one at the end of the third year, and another at the end of the fourth year. The O'Brien-Fleming alpha-spending function will be used to define the significance level of each interim analysis to ensure that the final overall two-sided significance level of α=0.05 is met.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 3
- Model description
- Multicenter, randomized, controlled, double-blind, triple-dummy clinical trial
| Arm | Type | Receives |
|---|---|---|
| Amlodipine (5mg/d) | Active comparator | Drug: Amlodipine besylate, Drug: Amlodipine folic acid placebo, Drug: 5-MTHF PlacebosAmlodipine 5mg x1 tablet + Amlodipine folic acid (dummy) x1 tablet + 5-MTHF (dummy) x2 tablets, taken orally, in the morning after waking up. Amlodipine tablets, amlodipine folic acid placebos, and 5-MTHF placebos are provided in aluminum-plastic blister plate. Each package includes 100 days of treatment drug (including 10 extra days of treatment for the follow-up window). A package of medication consists of 50 plates, each plate includes a total of 8 tablets arranged as follows: amlodipine 5mg x2 tablets + amlodipine folic acid (dummy) x2 tablets + 5-MTHF (dummy) x4 tablets. Affixed to the package is the randomized treatment drug label (400 tablets/package, 4 tablets/day). |
| Amlodipine folic acid (5.8mg/d) | Experimental | Drug: Amlodipine besylate And Folic Acid, Drug: Amlodipine placebo, Drug: 5-MTHF PlacebosAmlodipine folic acid 5.8mg x1 tablet + amlodipine (dummy) x1 tablet + 5-MTHF (dummy) x2 tablets, taken orally, in the morning after waking up. Amlodipine folic acid tablets, amlodipine placebos, and 5-MTHF placebos are provided in aluminum-plastic blister plate. Each package includes 100 days of treatment drug (including 10 extra days of treatment for the follow-up window). A package of medication consists of 50 plates, each plate includes a total of 8 tablets arranged as follows: amlodipine folic acid 5.8mg x2 tablets + amlodipine (dummy) x2 tablets + 5-MTHF (dummy) x4 tablets. Affixed to the package is the randomized treatment drug label (400 tablets/package, 4 tablets/day). |
| Amlodipine folic acid (5.8mg/d) + 5-MTHF (0.4mg/d) | Experimental | Drug: Amlodipine besylate And Folic Acid, Drug: 5-methyltetrahydrofolate (5-MTHF), Drug: Amlodipine placeboAmlodipine folic acid 5.8mg x1 tablet + 5-methyltetrahydrofolate 0.2mg x2 tablets + amlodipine (dummy) x1 tablet, taken orally, in the morning after waking up. Amlodipine folic acid tablets, 5-MTHF, and amlodipine placebos are provided in aluminum-plastic blister plate. Each package includes 100 days of treatment drug (including 10 extra days of treatment for the follow-up window). A package of medication consists of 50 plates, each plate includes a total of 8 tablets arranged as follows: amlodipine folic acid 5.8mg x2 tablets + amlodipine (dummy) x2 tablets + 5-MTHF, 0.2mg x4 tablets. Affixed to the package is the randomized treatment drug label (400 tablets/package, 4 tablets/day). |
Who may qualify
- Ages
- 45 to 74 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- Men and women, aged ≥45 and <75 years.
- Hypertension: Previously diagnosed with primary hypertension and has been taking antihypertensive medication within the past two weeks; OR has not been taking antihypertensive medications within the last two weeks, but meets the following criteria for hypertension: SBP≥140 mmHg and/or DBP≥90 mmHg (average of at least 2 measurements each time) at two separate (not on the same day) clinical visits.
- MTHFR 677 TT genotype (based on the test results from the central laboratory during the screening period or a previous official test report from a laboratory with medical testing qualifications).
- Voluntarily participates and has given signed informed consent.
- Good compliance during the run-in period, and unlikely to discontinue treatment;
Key exclusion criteria (26 listed)
- Previously diagnosed secondary hypertension;
- Previously diagnosed stroke;
- Previously diagnosed myocardial infarction;
- Previously diagnosed heart failure;
- Previously diagnosed atrial fibrillation;
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Amlodipine besylateAlso: AmlodipineThe amlodipine used in this study is a listed product. | Drug | Amlodipine (5mg/d) |
| Amlodipine besylate And Folic AcidAlso: Amlodipine Folic Acid, AnyeThe amlodipine besylate and folic acid tablets have been approved for listing by the China Food and Drug Administration, approval number: Zhunzi H20180020. | Drug | Amlodipine folic acid (5.8mg/d), Amlodipine folic acid (5.8mg/d) + 5-MTHF (0.4mg/d) |
| 5-methyltetrahydrofolate (5-MTHF)Also: 5-MTHFThe 5-MTHF used in this study is a listed product. | Drug | Amlodipine folic acid (5.8mg/d) + 5-MTHF (0.4mg/d) |
| Amlodipine placeboAlso: Amlodipine (dummy)Amlodipine placebos are dummy pills of amlodipine with identical appearance. | Drug | Amlodipine folic acid (5.8mg/d), Amlodipine folic acid (5.8mg/d) + 5-MTHF (0.4mg/d) |
| Amlodipine folic acid placeboAlso: Amlodipine folic acid (dummy)Amlodipine folic acid placebos are dummy pills of amlodipine folic acid with identical appearance. | Drug | Amlodipine (5mg/d) |
| 5-MTHF PlacebosAlso: 5-MTHF (dummy)5-MTHF placebos are the dummy pills of 5-MTHF with identical appearance. | Drug | Amlodipine (5mg/d), Amlodipine folic acid (5.8mg/d) |
Primary outcome
First ischemic stroke
Time frame: By the end of the fifth year of the study
The primary aim of the trial is to determine whether amlodipine folic acid tablets (including Group B and Group C), compared to amlodipine alone (Group A), can further reduce the risk of first ischemic stroke among eligible participants with hypertension and the MTHFR 677 TT genotype.
8 secondary outcomes
First ischemic stroke (for refined treatment group comparisons)
Time frame: By the end of the fifth year of the study
First stroke (ischemic and hemorrhagic)
Time frame: By the end of the fifth year from baseline
Composite cardiovascular endpoint (first non-fatal stroke, first non-fatal myocardial infarction, cardiovascular death)
Time frame: By the end of the fifth year from baseline
Kidney outcomes
Time frame: By the end of the fifth year from baseline
First hemorrhagic stroke
Time frame: By the end of the fifth year from baseline
First myocardial infarction
Time frame: By the end of the fifth year from baseline
First coronary revascularization (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI])
Time frame: By the end of the fifth year from baseline
Cardiovascular death
Time frame: By the end of the fifth year from baseline
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 26 Feb 2025.
- Background: PubMed 11800055Kjeldsen SE, Julius S, Hedner T, Hansson L. Stroke is more common than myocardial infarction in hypertension: analysis based on 11 major randomized intervention trials. Blood Press. 2001;10(4):190-2. doi: 10.1080/08037050152669684. No abstract available.
- Background: PubMed 9569395Collaboration HLT. Lowering blood homocysteine with folic acid based supplements: meta-analysis of randomised trials. Homocysteine Lowering Trialists' Collaboration. BMJ. 1998 Mar 21;316(7135):894-8.
- Background: PubMed 16210710Homocysteine Lowering Trialists' Collaboration. Dose-dependent effects of folic acid on blood concentrations of homocysteine: a meta-analysis of the randomized trials. Am J Clin Nutr. 2005 Oct;82(4):806-12. doi: 10.1093/ajcn/82.4.806.
- Background: PubMed 12920077Wilcken B, Bamforth F, Li Z, Zhu H, Ritvanen A, Renlund M, Stoll C, Alembik Y, Dott B, Czeizel AE, Gelman-Kohan Z, Scarano G, Bianca S, Ettore G, Tenconi R, Bellato S, Scala I, Mutchinick OM, Lopez MA, de Walle H, Hofstra R, Joutchenko L, Kavteladze L, Bermejo E, Martinez-Frias ML, Gallagher M, Erickson JD, Vollset SE, Mastroiacovo P, Andria G, Botto LD. Geographical and ethnic variation of the 677C>T allele of 5,10 methylenetetrahydrofolate reductase (MTHFR): findings from over 7000 newborns from 16 areas world wide. J Med Genet. 2003 Aug;40(8):619-25. doi: 10.1136/jmg.40.8.619. No abstract available.
- Background: PubMed 18511872Xu X, Li J, Sheng W, Liu L. Meta-analysis of genetic studies from journals published in China of ischemic stroke in the Han Chinese population. Cerebrovasc Dis. 2008;26(1):48-62. doi: 10.1159/000135653. Epub 2008 May 30.
- Results publication: PubMed 22230384Qin X, Li J, Cui Y, Liu Z, Zhao Z, Ge J, Guan D, Hu J, Wang Y, Zhang F, Xu X, Wang X, Xu X, Huo Y. MTHFR C677T and MTR A2756G polymorphisms and the homocysteine lowering efficacy of different doses of folic acid in hypertensive Chinese adults. Nutr J. 2012 Jan 10;11:2. doi: 10.1186/1475-2891-11-2.
- Results publication: PubMed 21869730Qin X, Li J, Cui Y, Liu Z, Zhao Z, Ge J, Guan D, Hu J, Wang Y, Zhang F, Xu X, Wang X, Xu X, Huo Y. Effect of folic acid intervention on the change of serum folate level in hypertensive Chinese adults: do methylenetetrahydrofolate reductase and methionine synthase gene polymorphisms affect therapeutic responses? Pharmacogenet Genomics. 2012 Jun;22(6):421-8. doi: 10.1097/FPC.0b013e32834ac5e8.
- Results publication: PubMed 22880024Qin X, Li J, Zhang Y, Ma W, Fan F, Wang B, Xing H, Tang G, Wang X, Xu X, Xu X, Huo Y. Prevalence and associated factors of diabetes and impaired fasting glucose in Chinese hypertensive adults aged 45 to 75 years. PLoS One. 2012;7(8):e42538. doi: 10.1371/journal.pone.0042538. Epub 2012 Aug 3.
- Results publication: PubMed 22897803Dong Q, Tang G, He M, Cai Y, Cai Y, Xing H, Sun L, Li J, Zhang Y, Fan F, Wang B, Sun N, Liu L, Xu X, Hou F, Shen H, Xu X, Huo Y. Methylenetetrahydrofolate reductase C677T polymorphism is associated with estimated glomerular filtration rate in hypertensive Chinese males. BMC Med Genet. 2012 Aug 16;13:74. doi: 10.1186/1471-2350-13-74.
- Results publication: PubMed 25771069Huo Y, Li J, Qin X, Huang Y, Wang X, Gottesman RF, Tang G, Wang B, Chen D, He M, Fu J, Cai Y, Shi X, Zhang Y, Cui Y, Sun N, Li X, Cheng X, Wang J, Yang X, Yang T, Xiao C, Zhao G, Dong Q, Zhu D, Wang X, Ge J, Zhao L, Hu D, Liu L, Hou FF; CSPPT Investigators. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. JAMA. 2015 Apr 7;313(13):1325-35. doi: 10.1001/jama.2015.2274.
- Results publication: PubMed 29030456Huang X, Li Y, Li P, Li J, Bao H, Zhang Y, Wang B, Sun N, Wang J, He M, Yin D, Tang G, Chen Y, Cui Y, Huang Y, Hou FF, Qin X, Huo Y, Cheng X. Association between percent decline in serum total homocysteine and risk of first stroke. Neurology. 2017 Nov 14;89(20):2101-2107. doi: 10.1212/WNL.0000000000004648. Epub 2017 Oct 13.
- Results publication: PubMed 27834686Qin X, Li Y, Sun N, Wang H, Zhang Y, Wang J, Li J, Xu X, Liang M, Nie J, Wang B, Cheng X, Li N, Sun Y, Zhao L, Wang X, Hou FF, Huo Y. Elevated Homocysteine Concentrations Decrease the Antihypertensive Effect of Angiotensin-Converting Enzyme Inhibitors in Hypertensive Patients. Arterioscler Thromb Vasc Biol. 2017 Jan;37(1):166-172. doi: 10.1161/ATVBAHA.116.308515. Epub 2016 Nov 10.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Jianping Li, MD, PhD principal investigator
Peking University First Hospital
20 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Amlodipine besylate, Amlodipine besylate And Folic Acid and 5-methyltetrahydrofolate (5-MTHF) in people with Hypertension and MTHFR 677 TT Genotype, run by Shenzhen Ausa Pharmed Co.,Ltd at 20 sites in China.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 26 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 26 Feb 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 20 sites in China. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Minqing Tian, PhD (86-18818680849, tianminqing@163.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
First ischemic stroke (time frame: By the end of the fifth year of the study). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04974151, which also lists 12 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Feb 2025.