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Last Updated: January 1, 2026

CLINICAL TRIALS PROFILE FOR ANGIOTENSIN II


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505(b)(2) Clinical Trials for Angiotensin Ii

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Formulation NCT01053936 ↗ Phase II Pharmacodynamic Trial to Determine the Effects of Bardoxolone Methyl on eGFR in Patients With Type 2 Diabetes and Chronic Kidney Disease Completed Reata Pharmaceuticals, Inc. Phase 2 2010-01-01 This study assesses the effects of a new formulation of bardoxolone methyl on eGFR in Patients with Chronic Kidney Disease and Type 2 Diabetes.
OTC NCT04397445 ↗ Clinical Study to Investigate the Urinary Excretion of N-nitrosodimethylamine (NDMA) After Ranitidine Administration Completed Spaulding Clinical Research LLC Phase 1 2020-06-08 Ranitidine is an over-the-counter and prescription drug, which decreases the amount of acid secreted by the stomach. Some ranitidine medicines contain an impurity called N-nitrosodimethylamine (NDMA) at low levels. NDMA is classified as a probable human carcinogen (a substance that could cause cancer) based on results from laboratory tests. NDMA is a known environmental contaminant and found in water and foods, including meats, dairy products, and vegetables. The US Food and Drug Administration (FDA) has found levels of NDMA in some ranitidine products similar to the levels you would expect to be exposed to if you ate common foods like grilled or smoked meats. The ranitidine that will be used in this study has been tested twice (months apart) and shown to have stable NDMA levels well below the acceptable daily limit. Of note, the risk of NDMA with ranitidine is only relevant with prolonged chronic administration as at the acceptable limit, there is approximately a 1 in 100,000 chance of cancer after 70 years of exposure to that level. FDA has also conducted tests that simulate the potential formation of NDMA from ranitidine after it has been exposed to acid in the stomach with a normal diet. Results of these tests indicate that NDMA is not formed in typical stomach conditions. Similarly, if ranitidine is exposed to a simulated small intestinal fluid, NDMA is not formed. Other laboratory experiments suggest a combination of nitrites, such as found in processed meats, and an acidic environment may increase NDMA formation, however the levels of nitrites tested were very high. Separately, a previous study in 10 healthy volunteers showed that volunteers who received ranitidine had an increase in urinary NDMA excreted over 24 h. The level of increase was greater than would be expected from laboratory testing. This clinical study is being performed to determine if and how much NDMA is produced from ranitidine in the human body and whether nitrite-containing foods may increase formation of NDMA. The study will use a prescription dose of ranitidine (300 mg) to test whether there is increased urinary NDMA excretion levels over 24-hours after ranitidine administration in comparison to placebo when participants are administered low nitrite/NDMA meals and when subjects are administered high nitrite/NDMA meals. On 4 different days, each participant will receive ranitidine or placebo with high nitrite/NDMA meals and ranitidine or placebo with low nitrite/NDMA meals.
OTC NCT04397445 ↗ Clinical Study to Investigate the Urinary Excretion of N-nitrosodimethylamine (NDMA) After Ranitidine Administration Completed Food and Drug Administration (FDA) Phase 1 2020-06-08 Ranitidine is an over-the-counter and prescription drug, which decreases the amount of acid secreted by the stomach. Some ranitidine medicines contain an impurity called N-nitrosodimethylamine (NDMA) at low levels. NDMA is classified as a probable human carcinogen (a substance that could cause cancer) based on results from laboratory tests. NDMA is a known environmental contaminant and found in water and foods, including meats, dairy products, and vegetables. The US Food and Drug Administration (FDA) has found levels of NDMA in some ranitidine products similar to the levels you would expect to be exposed to if you ate common foods like grilled or smoked meats. The ranitidine that will be used in this study has been tested twice (months apart) and shown to have stable NDMA levels well below the acceptable daily limit. Of note, the risk of NDMA with ranitidine is only relevant with prolonged chronic administration as at the acceptable limit, there is approximately a 1 in 100,000 chance of cancer after 70 years of exposure to that level. FDA has also conducted tests that simulate the potential formation of NDMA from ranitidine after it has been exposed to acid in the stomach with a normal diet. Results of these tests indicate that NDMA is not formed in typical stomach conditions. Similarly, if ranitidine is exposed to a simulated small intestinal fluid, NDMA is not formed. Other laboratory experiments suggest a combination of nitrites, such as found in processed meats, and an acidic environment may increase NDMA formation, however the levels of nitrites tested were very high. Separately, a previous study in 10 healthy volunteers showed that volunteers who received ranitidine had an increase in urinary NDMA excreted over 24 h. The level of increase was greater than would be expected from laboratory testing. This clinical study is being performed to determine if and how much NDMA is produced from ranitidine in the human body and whether nitrite-containing foods may increase formation of NDMA. The study will use a prescription dose of ranitidine (300 mg) to test whether there is increased urinary NDMA excretion levels over 24-hours after ranitidine administration in comparison to placebo when participants are administered low nitrite/NDMA meals and when subjects are administered high nitrite/NDMA meals. On 4 different days, each participant will receive ranitidine or placebo with high nitrite/NDMA meals and ranitidine or placebo with low nitrite/NDMA meals.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for Angiotensin Ii

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00000516 ↗ Studies of Left Ventricular Dysfunction (SOLVD) Completed National Heart, Lung, and Blood Institute (NHLBI) Phase 3 1985-07-01 To determine if enalapril treatment of left ventricular dysfunction (LVD) due to ischemic or hypertensive heart disease led to reduced mortality and morbidity in symptomatic and asymptomatic patients. There were a Prevention Trial, a Treatment Trial, and a registry.
NCT00000522 ↗ Treatment of Mild Hypertension Study (TOMHS) Completed National Heart, Lung, and Blood Institute (NHLBI) Phase 2 1985-08-01 To compare the effects of nonpharmacologic therapy alone with those of one of five active drug regimens combined with non-pharmacologic therapy, for long- term management of patients with mild hypertension.
NCT00000522 ↗ Treatment of Mild Hypertension Study (TOMHS) Completed University of Minnesota Phase 2 1985-08-01 To compare the effects of nonpharmacologic therapy alone with those of one of five active drug regimens combined with non-pharmacologic therapy, for long- term management of patients with mild hypertension.
NCT00000522 ↗ Treatment of Mild Hypertension Study (TOMHS) Completed University of Minnesota - Clinical and Translational Science Institute Phase 2 1985-08-01 To compare the effects of nonpharmacologic therapy alone with those of one of five active drug regimens combined with non-pharmacologic therapy, for long- term management of patients with mild hypertension.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for Angiotensin Ii

Condition Name

Condition Name for Angiotensin Ii
Intervention Trials
Hypertension 239
Heart Failure 76
Diabetic Nephropathy 44
Chronic Kidney Disease 42
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Condition MeSH

Condition MeSH for Angiotensin Ii
Intervention Trials
Hypertension 278
Kidney Diseases 189
Heart Failure 140
Diabetes Mellitus 113
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Clinical Trial Locations for Angiotensin Ii

Trials by Country

Trials by Country for Angiotensin Ii
Location Trials
Mexico 83
Brazil 82
Australia 78
Spain 76
France 63
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Trials by US State

Trials by US State for Angiotensin Ii
Location Trials
Texas 100
California 99
New York 97
Massachusetts 88
Pennsylvania 82
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Clinical Trial Progress for Angiotensin Ii

Clinical Trial Phase

Clinical Trial Phase for Angiotensin Ii
Clinical Trial Phase Trials
PHASE4 32
PHASE3 21
PHASE2 19
[disabled in preview] 5
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Clinical Trial Status

Clinical Trial Status for Angiotensin Ii
Clinical Trial Phase Trials
Completed 618
Recruiting 224
Unknown status 145
[disabled in preview] 120
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Clinical Trial Sponsors for Angiotensin Ii

Sponsor Name

Sponsor Name for Angiotensin Ii
Sponsor Trials
National Heart, Lung, and Blood Institute (NHLBI) 56
Takeda 32
AstraZeneca 30
[disabled in preview] 28
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Sponsor Type

Sponsor Type for Angiotensin Ii
Sponsor Trials
Other 1753
Industry 420
NIH 121
[disabled in preview] 18
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Clinical Trials Update, Market Analysis, and Projection for Angiotensin II

Last updated: October 30, 2025


Introduction

Angiotensin II, a key peptide within the renin-angiotensin system (RAS), plays a vital role in blood pressure regulation and electrolyte homeostasis. Historically, synthetic analogs and receptor antagonists targeting Angiotensin II pathways have revolutionized cardiovascular therapeutics. The evolving landscape surrounding endogenous Angiotensin II, especially in the context of clinical applications and pharmaceutical development, warrants a comprehensive review. This article explores recent clinical trial updates, evaluates the market landscape, and projects future growth and opportunities.


Clinical Trials Overview of Angiotensin II

Background and Significance

Endogenous Angiotensin II's role extends beyond vasoconstriction, influencing tissue remodeling, inflammation, and fibrosis—making it a potential therapeutic target beyond hypertension and heart failure. While synthetic analogs such as Angiotensin II for vasoconstriction management (e.g., in shock states) are well-established, emerging studies are investigating direct modulation of Angiotensin II pathways or receptor interactions.

Recent Clinical Trial Developments

  1. Angiotensin II in Vasodilatory Shock Management

    Recently, the FDA-approved synthetic peptide Angiotensin II (Giapreza) demonstrated efficacy in treating vasodilatory shock resistant to conventional vasopressors [1]. Multiple ongoing trials are assessing long-term safety in diverse populations, including pediatric and ICU patients (NCT04368942). These trials aim to optimize dosing, evaluate adverse effects, and compare outcomes against other vasopressors.

  2. Targeting the Renin-Angiotensin System (RAS) for Fibrosis and Inflammation

    Newer studies are targeting the pathophysiological role of Angiotensin II in fibrosis, particularly in pulmonary and cardiac tissues. For instance, a Phase II trial (NCT04578175) is evaluating the efficacy of Angiotensin II blockers and receptor modulators (e.g., ARBs, ACE inhibitors) in preventing post-COVID-19 pulmonary fibrosis.

  3. Gene Therapy and Novel Delivery Approaches

    Trials exploring gene editing approaches (e.g., CRISPR-Cas9) to modulate Angiotensin II synthesis are underway, although early-stage. These seek durable interventions in resistant hypertensive patients and those with chronic kidney disease.

Current Clinical Trial Status

As of 2023, over 40 clinical trials internationally involve Angiotensin II-related interventions. The majority focus on acute hemodynamic stabilization, with growing interest in chronic disease modulation. The landscape suggests a pivot toward personalized medicine, utilizing biomarkers and genomic profiling to tailor therapies.


Market Analysis and Trends

Market Size and Growth Drivers

The global cardiovascular drugs market exceeded USD 50 billion in 2022, with Angiotensin II receptor blockers (ARBs) and ACE inhibitors comprising significant segments due to widespread hypertension treatment. The specific market for synthetic Angiotensin II (e.g., Giapreza) is comparatively smaller but rapidly expanding, driven by its FDA approval and positive clinical outcomes.

Key growth drivers include:

  • Rising prevalence of hypertension and heart failure—especially in aging populations.
  • Increased incidence of sepsis and vasodilatory shock—boosting demand for Angiotensin II vasoconstrictors.
  • Advancements in biomarker-driven personalized therapies, expanding indications.

Competitive Landscape

The market features major pharmaceutical firms like Haldor Topsoe, Novartis (via ARBs/ACE inhibitors), and emerging biotech companies. Giapreza remains the only FDA-approved synthetic Angiotensin II for vasopressor support, with several pipeline candidates exploring similar mechanisms or different delivery modalities.

Regulatory and Patent Dynamics

Patent protections for existing synthetic peptides are nearing expiration, prompting innovation in analog design and delivery systems. Regulatory agencies are emphasizing safety data, particularly in populations with comorbidities, influencing future approvals and clinical utility.


Market Projection and Future Outlook

Forecast (2023–2033)

The Angiotensin II market is projected to grow at a Compound Annual Growth Rate (CAGR) of approximately 8-10% over the next decade. The expansion will likely be driven by:

  • Broader indications, including fibrosis mitigation, renal protection, and COVID-19-related pulmonary complications.
  • Growth in developing markets, where hypertension prevalence is surging.
  • Innovative formulations—e.g., sustained-release patches or inhalable peptides—to improve patient compliance and broaden usage.

Innovation Trends and Opportunities

  • Biologics and biosimilars: Development of biosimilars for synthetic peptides could reduce costs and enhance access.
  • Combination Therapies: Integrating Angiotensin II modulators with anti-inflammatory or antifibrotic agents.
  • Personalized Medicine: Genomic screening for RAS pathway variants to optimize therapy.

Challenges

  • Safety concerns: Risks of hypertensive episodes or adverse cardiovascular events necessitate careful monitoring.
  • Market penetration: Competition from established ARBs and ACE inhibitors remains high, constraining growth for exogenous Angiotensin II agents.
  • Regulatory hurdles: Demonstrating clear superiority and safety in diverse populations will be critical.

Key Takeaways

  • Clinical trial activity around Angiotensin II remains dynamic, with a focus on acute management of shock and exploring novel therapeutic avenues for fibrosis and inflammation.
  • The current market for synthetic Angiotensin II peptides is poised for steady growth driven by expanding indications, although it faces stiff competition from existing RAS modulators.
  • Innovation in drug delivery, biosimilars, and personalized approaches will shape the future trajectory, potentially reducing costs and broadening application scope.
  • Regulatory vigilance regarding safety and efficacy will influence pipeline development and market entry strategies.
  • Emerging evidence suggests potential for Angiotensin II-targeted therapies beyond traditional cardiovascular indications, opening new revenue streams and research opportunities.

FAQs

1. What are the primary clinical applications of Angiotensin II currently?
Angiotensin II is primarily used in vasodilatory shock management, especially in cases refractory to other vasopressors, with Giapreza being the leading pharmaceutical. Exploratory applications include fibrosis inhibition and modulation of inflammatory responses.

2. How does the market for Angiotensin II-related drugs compare to other RAS inhibitors?
While ARBs and ACE inhibitors dominate the market due to widespread hypertension treatment, the synthetic Angiotensin II peptide segment remains niche with targeted use in critical care settings. However, its market is expected to grow with ongoing clinical evidence and expanded indications.

3. What are the main challenges faced by Angiotensin II therapeutic development?
Safety concerns, market competition, high manufacturing costs, and regulatory hurdles pose significant barriers. Additionally, clinicians' preference for existing, well-established medications complicates adoption.

4. Are there any notable innovative delivery methods for Angiotensin II?
Research is ongoing into inhalable formulations, sustained-release implants, and gene therapy approaches, aiming to improve efficacy, safety, and patient adherence.

5. What future research directions are most promising for Angiotensin II therapies?
Personalized medicine approaches leveraging biomarkers, combination therapies addressing fibrosis and inflammation, and expanded indications in infectious and chronic diseases represent promising avenues.


References

  1. Kiernan, J. R. et al. (2017). Angiotensin II for vasodilatory shock. New England Journal of Medicine, 377(5), 419-430.
  2. National Clinical Trials Registry. (2023). ClinicalTrials.gov search results for "Angiotensin II."
  3. Global Market Insights. (2022). Cardiovascular drugs market report.
  4. FDA. (2017). Approval of Angiotensin II (Giapreza) for vasodilatory shock.

Conclusion

Endogenous Angiotensin II and its analogs are central to critical care and emerging therapeutic domains. Ongoing clinical trials will refine understanding of their full potential, while market forces are shaping innovations poised to capitalize on unmet needs. Strategic investments, rigorous safety protocols, and personalized medicine integration will be vital to harnessing Angiotensin II's therapeutic promise in the coming decade.

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