Open-label inteRventional Clinical Trial to Assess Efficacy and Safety of the exteMporaneous combInation of Nebivolol and Ramipril in hypertenSIve pAtients

Prior treatment

• Acute heart failure (12 months before enrolment), cardiogenic shock, or episodes of heart failure decompensation requiring intravenous inotropic therapy.
• Participation in another interventional study within the last 30 days before Screening Visit (Visit 1).
• Patients using and not suitable for withdrawing the prohibited medications prior to the administration of study treatment.
• History of unexplained syncope within the prior 2 years, or a known syncopal disorder.
• Patients who received renal denervation in the last 3 years or other device-based nonpharmacological treatment of hypertension.

Other illness

• Patients with documented history of hypersensitivity to NEB, RAM, other BBs or other ACE-is, or any related products, excipients of the formulations, as outlined in the relevant Investigator's Brochure (IB), summary of product characteristics (SmPC) or local package inserts for Nebivolol and Ramipril.
• Patients with serious disorders (in the opinion of the Investigator) which may limit the ability to evaluate the efficacy or safety of the tested medications, including cerebrovascular, cardiovascular, renal, respiratory, hepatic, gastrointestinal, endocrine, or metabolic, hematological, or oncological, neurological, and psychiatric diseases. The same applies for immunocompromised and/or neutropenic patients.
• Patients having a history of the following conditions within the last 6 months:
  • myocardial infarction, unstable angina pectoris, percutaneous coronary intervention, bypass surgery, heart failure, hypertensive encephalopathy, valve replacement (transcatheter aortic valve implantation, mitraclip), cerebrovascular accident (stroke), or transient ischemic attack.
• Patients with condition of hypotension with SBP \< 90 mmHg and/or DBP \< 60 mmHg.
• Patients with secondary hypertension of any etiology including renal diseases, Cushing's syndrome, hyperaldosteronism, renovascular disease and thyroid disorders.
• Patients with severe heart failure (New York Heart Association classification III-IV) a narrowing of the aortic or bicuspid valve, an obstruction of cardiac outflow (obstructive, hypertrophic cardiomyopathy), obstruction of the outflow tract of the left ventricle (e.g., high grade aortic stenosis) or symptomatic coronary disease.
• Patients with clinical evidence of renal disease (including significant bilateral renal artery stenosis or renal artery stenosis in a single functioning kidney), severe renal impairment or renal transplant.
• Patients with clinically relevant hepatic impairment.
• Patients with a history of angioneurotic edema.
• Patients with sick sinus syndrome, including sino-atrial block.
• Patient with second- and third-degree heart block (without a pacemaker).
• History of bronchospasm and bronchial asthma.
• Patients with bradycardia (heart rate \< 60 bpm; \< 50 bpm in patients already on BBs treatment).
• Patient with history of metabolic acidosis.
• Patients with diseases that, in the opinion of the Investigator, prevent a careful adherence to the protocol.
• Patients with medical history of cirrhosis (Child Pugh class B or higher).

Other

• Any patient who meets any of the following criteria will not qualify for entry into the study:
• Untreated phaeochromocytoma.
• Patients with severe peripheral circulatory disturbances.
• Pregnant and breastfeeding women. NOTE: a pregnancy test will be performed on all women of childbearing potential at each study visit.
• Any other contraindication to either NEB or RAM as per respective SmPC.

• Patient will be considered eligible to be enrolled in the study only if he/she meets all the following inclusion criteria:
• Willing to comply with all study activities and procedures for the duration of the study and provided signed, written informed consent prior to any study procedures at Screening Visit.
• Male or female patients aged ≥ 18 years with hypertension with mean sitting SBP ≥ 140 mmHg and ≤ 179 mmHg and/or mean sitting DBP ≥ 90 mmHg and
  • ≤ 109 mmHg at Visit 1 (screening), while on monotherapy treatment either with BBs (NEB 5 mg or any dose if other BB) or ACE-is (RAM 5 mg or any dose if other ACE-i) for at least 30 days before Visit 1 (screening) and, as per Investigator's judgement, is deemed appropriate for a combination treatment with BB and ACE-i.
• Ability to take oral medication and willing to adhere to the drug regimen.
• Female patient of childbearing potential is eligible to participate if she is not pregnant, or not breastfeeding. A woman is considered fertile following menarche and until becoming postmenopausal unless permanently sterile. Women of childbearing potential must agree to use of highly effective contraception (e.g., method of birth control throughout the study period and for 4 weeks after study completion defined as a method which results in a failure rate of less than 1% per year) and also must refrain from donating or storing eggs during this time. Highly effective contraception methods can be:
  • Combined hormonal contraception (estrogen- and progestogen-containing) associated with inhibition of ovulation (oral, intravaginal, and transdermal).
  • Progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, and implantable).
  • Intrauterine device.
  • Intrauterine hormone-releasing system.
  • Bilateral tubal occlusion.
  • Vasectomized partner (procedure conducted at least 2 months before the screening), (provided that partner is the sole sexual partner of the trial participant and that the vasectomized partner has received medical assessment of the surgical success).
• A male patient must agree to use contraception during the whole study period and for at least 1 week after the last dose of study treatment and refrain from donating sperm during this period.