Comparative effects of aliskiren-based and ramipril-based therapy on the renin system during long-term (6 months) treatment and withdrawal in patients with hypertension

Andersen, Karl; Weinberger, Myron H.; Constance, Christian C.; Ali, Mohammed A.; Jin, James; Prescott, Margaret F.; Keefe, Deborah L.

doi:10.1177/1470320309342407

Cited by 44 publications

(41 citation statements)

References 34 publications

(44 reference statements)

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“…The remaining 16 articles were retrieved for full-text review. Eleven of those articles were excluded for the following reasons: two had data that were not extractable (Andersen et al, 2008;Andersen et al, 2009), three presented excluded study designs (O'Brien et al, 2007;Chrysant et al, 2008;Littlejohn et al, 2009), one enrolled patients with severe hypertension (Strasser et al, 2007), four appeared only in the abstract form (Sica et al, 2006;Prescott et al, 2007;Calhoun et al, 2008) and one was indexed in MEDLINE in duplicate (Nickenig et al, 2008). Therefore, after exclusion criteria were applied, a total of 5 studies involving a total of 5508 patients were included in this analysis [20][21][22][23][24].…”

Section: Resultsmentioning

confidence: 99%

Efficacy of Aliskiren/Hydrochlorothiazide Combination for the Treatment of Hypertension: A Meta-Analytical Revision

Morgado¹,

Rolo²,

Castelo‐Branco³

2012

Pharmacotherapy

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Section: Resultsmentioning

confidence: 99%

Efficacy of Aliskiren/Hydrochlorothiazide Combination for the Treatment of Hypertension: A Meta-Analytical Revision

Morgado¹,

Rolo²,

Castelo‐Branco³

2012

Pharmacotherapy

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“…Their findings strongly support our own results. Aliskiren exerts an antihypertensive effect that is independent of the serum renin activity, and it is possible to obtain an adequate antihypertensive effect even in the elderly (17). Moreover, higher blood aliskiren concentrations have been reported to be maintained in the elderly compare with younger people (18).…”

Section: Discussionmentioning

confidence: 99%

Antihypertensive Efficacy of the Direct Renin Inhibitor Aliskiren as Add-on Therapy in Patients with Poorly Controlled Hypertension

et al. 2016

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Objective A direct renin inhibitor, aliskiren, has a longer stable antihypertensive effect compared with other renin-angiotensin-aldosterone system (RAAS) inhibitors. Methods This study was a 6-month, single-center, open trial conducted between December 2010 and November 2011 to assess the antihypertensive effect of adding aliskiren (300 mg) to the treatment of essential hypertension patients whose target blood pressure (BP) had not been achieved and to assess whether it was possible to reduce the amount of antihypertensive drugs used. Results The results showed an overall improvement in the target BP achievement rate of 60% for clinic BP and 52% for home BP measurements (75 cases total). The mean number of drugs before treatment with aliskiren was 3.28±1.52, whereas at the end of the six months the mean number of drugs prescribed other than aliskiren was 2.85±1.72 (p<0.0001). Moreover, no worsening of the renal function was observed in patients with diabetes or chronic kidney disease (CKD) who were being treated with other RAAS inhibitors in combination to aliskiren. Conclusion These results showed that when aliskiren was added to the treatment of poorly controlled hypertension, the BP achievement rate increased, and it was possible to reduce the amount of antihypertensive drugs used in combination with aliskiren. Moreover, as a result of careful monitoring of the renal function or decreasing the amounts of drugs used in combination, no worsening of the renal function was observed even in the cases complicated by diabetes or CKD being treated with other RAAS inhibitors.

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“…Two good-quality RCTs compared the DRI aliskiren at a maximum dose of 300 mg to the ACE inhibitor ramipril at a maximum dose of 10 mg. [11][12][13] In both studies, aliskiren produced a greater reduction in blood pressure at 12 weeks, with between-group blood pressure (SBP/ DBP) differences of −2.7/-1.6…”

Section: Comparisons With Direct Renin Inhibitorsmentioning

confidence: 92%

“…Only nine studies reported enrollment of at least 10% black patients. 11,12,24,47,51,61,63,74,86,90 The funding source was reported in 47 studies (59%), …”

Section: Blood Pressure Controlmentioning

confidence: 99%

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Updated Report on Comparative Effectiveness of ACE inhibitors, ARBs, and Direct Renin Inhibitors for Patients with Essential Hypertension: Much More Data, Little New Information

et al. 2011

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OBJECTIVES:A 2007 systematic review compared angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in patients with hypertension. Direct renin inhibitors (DRIs) have since been introduced, and significant new research has been published. We sought to update and expand the 2007 review. DATA SOURCES: We searched MEDLINE and EMBASE (through December 2010) and selected other sources for relevant English-language trials. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: We included studies that directly compared ACE inhibitors, ARBs, and/or DRIs in at least 20 total adults with essential hypertension; had at least 12 weeks of follow-up; and reported at least one outcome of interest. Ninety-seven (97) studies (36 new since 2007) directly comparing ACE inhibitors versus ARBs and three studies directly comparing DRIs to ACE inhibitor inhibitors or ARBs were included. STUDY APPRAISAL AND SYNTHESIS METHODS: A standard protocol was used to extract data on study design, interventions, population characteristics, and outcomes; evaluate study quality; and summarize the evidence. RESULTS: In spite of substantial new evidence, none of the conclusions from the 2007 review changed. The level of evidence remains high for equivalence between ACE inhibitors and ARBs for blood pressure lowering and use as single antihypertensive agents, as well as for superiority of ARBs for short-term adverse events (primarily cough). However, the new evidence was insufficient on long-term cardiovascular outcomes, quality of life, progression of renal disease, medication adherence or persistence, rates of angioedema, and differences in key patient subgroups. LIMITATIONS: Included studies were limited by followup duration, protocol heterogeneity, and infrequent reporting on patient subgroups. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:Evidence does not support a meaningful difference between ACE inhibitors and ARBs for any outcome except medication side effects. Few, if any, of the questions that were not answered in the 2007 report have been addressed by the 36 new studies. Future research in this area should consider areas of uncertainty and be prioritized accordingly. CLINICAL CASEA 54-year-old woman with a history of hypertension is seen by her doctor for persistently elevated blood pressure in spite of adherence to hydrochlorothiazide 25 mg daily. She is overweight and has a strong family history of coronary artery disease. To control her blood pressure, she and her doctor discuss adding an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin II receptor blocker (ARB), or a direct renin inhibitor (DRI) to her regimen. She is primarily interested in avoiding the cardiovascular complications of hypertension, but does not want to take medication more than once a day, and she is concerned about side effects and the cost of her medication. What information is available to help guide her decision?Electronic supplementary material The online version of this article

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Comparative effects of aliskiren-based and ramipril-based therapy on the renin system during long-term (6 months) treatment and withdrawal in patients with hypertension

Cited by 44 publications

References 34 publications

Efficacy of Aliskiren/Hydrochlorothiazide Combination for the Treatment of Hypertension: A Meta-Analytical Revision

Efficacy of Aliskiren/Hydrochlorothiazide Combination for the Treatment of Hypertension: A Meta-Analytical Revision

Antihypertensive Efficacy of the Direct Renin Inhibitor Aliskiren as Add-on Therapy in Patients with Poorly Controlled Hypertension

Updated Report on Comparative Effectiveness of ACE inhibitors, ARBs, and Direct Renin Inhibitors for Patients with Essential Hypertension: Much More Data, Little New Information

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