Effect of Aliskiren in Patients with Heart Failure According to Background Dose of ACE Inhibitor: A Retrospective Analysis of the Aliskiren Observation of Heart Failure Treatment (ALOFT) Trial

Sidik, Novalia; Solomon, Scott D.; Latini, Roberto; Maggioni, Aldo P.; Wright, Melanie; Gimpelewicz, Claudio; Pitt, Bertram; McMurray, John J.V.

doi:10.1007/s10557-011-6319-3

Cited by 9 publications

(6 citation statements)

References 17 publications

(26 reference statements)

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“…The study AGELESS proved the superiority of antihypertensive effect of Aliskiren compared to ramipril with a similar safety profile and significantly lower rates of cough as a side effect [2]. ALOFT (Aliskiren Observation of Heart Failure Treatment) program provided strong evidence that Aliskiren could significantly reduce BNP and NT-proBNP levels in patients with heart failure on conventional therapy compared to placebo [3,15,16]. The effect of the direct renin inhibitor on morbidity and mortality has been studied in patients with heart failure ATMOSPHERE (Aliskiren Trial to Minimize OutcomeS in Patients with HEart failuRE), compensated patients, hospitalized for an acute heart failure ASTRONAUT (Aliskiren Trial on Acute Heart Failure Outcomes), as well as in adults (APOLLO) [2].…”

Section: Discussionmentioning

confidence: 99%

Does Aliskiren Influence the Changes of Global Longitudinal Strain in Patients with Diastolic Dysfunction?

Manov¹,

Runev²,

Naydenov³

et al. 2013

UCMS

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Abstract:The aim of our study was to investigate the effects of Aliskiren on the blood pressure values as well as on the myocardial function, assessed by GLS (global longitudinal strain) in patients with uncontrolled АH (arterial hypertension) and diastolic dysfunction. Forty five nondiabetic patients (29 men and 16 women, mean age 58.7 ± 12.4 years) with BP (blood pressure) > 140/90 mm Hg despite of combined antihypertensive therapy (diuretic, calcium channel blockers, beta-blockers) were evaluated. All of them had echocardiographic data for diastolic dysfunction: Е/Е' ratio ≤ 8, Е/А ratio < 0.8, DT (deceleration time) > 200 ms. Aliskiren 2 × 150 mg per day was added to the previous therapy. The follow-up period was 1 year, including monthly clinical visits. Echocardiographic assessment of the left ventricular function by longitudinal strain and Doppler analysis of the transmitral blood flow was performed at months 1, 6 and 12. The baseline mean measurements of systolic and diastolic BP values showed (153.4 ± 14.4)/(99.2 ± 6.7) mmHg for males and (157.6 ± 12.5)/(97.3 ± 8.2) mmHg for females. The systolic and diastolic BP values at the end of the 1st month were (131.7 ± 7.4)/(83.6 ± 5.2) mmHg in men and (132.4 ± 5.3)/(81.8 ± 6.9) mmHg in women (Р < 0.05, compared to the initial BP values). The baseline ratio of Е/Е' was found to be 6.5 ± 0.9, Е/А-0.6 ± 0.01 and DT-258 ± 32.7 ms. The values of these parameters at month 12 were as follows: Е/Е'-7.0 ± 0.64, Е/А-0.7 ± 0.05, DT-239 ± 16.5 ms (Р = NS). Baseline global longitudinal strain in men was -10.4 ± 0.7% and -11.0 ± 0.9% in women, whereas GLS at month 12 showed values of: (-16.3 ± 0.9%) and (-17.5 ± 0.7%) for males and females respectively (Р < 0.05). During the whole period of treatment with Aliskiren and follow-up no adverse effects were registered. Aliskiren, added to a combined antihypertensive therapy (without RAAS-renin-angiotensin-aldosterone system blocker) in patients with uncontrolled AH and diastolic dysfunction provides not only a better BP control, but also a significant improvement of the myocardial function, assessed by global longitudinal strain. The 12 months treatment with Aliskiren was safe and well tolerated.

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Section: Discussionmentioning

confidence: 99%

Does Aliskiren Influence the Changes of Global Longitudinal Strain in Patients with Diastolic Dysfunction?

Manov¹,

Runev²,

Naydenov³

et al. 2013

UCMS

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“…Aliskiren, apart from being efficacious in controlling BP in monotherapy, has also been demonstrated to decrease albuminuria, lower BP, normalise serum creatinine, inhibit atherosclerosis development, and improve plaque stability in animal models [69,70]. Large trials, including the Aliskiren in the Evaluation of proteinuria in Diabetes (AVOID) trial [71] and the Aliskiren Observation of Heart Failure Treatment (ALOFT) trial [72] also revealed the reduction of urine albumin to creatinine ratio (UACR) and neurohumoral suppression in heart failure.…”

Section: Treatment Of Ckd Patients -Novel Recommendationsmentioning

confidence: 99%

Novel strategies of hypertension management in chronic kidney disease

et al. 2020

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Hypertension is the most frequent comorbidity affecting patients with chronic kidney disease. It causes functional and structural changes in the kidney. According to the results of the Chronic Renal Insufficiency Cohort (CRIC) study, 67% to 92% of patients with chronic kidney disease (CKD) suffer from hypertension, with increasing prevalence as kidney function declines. Hypertension is a complex polygenic disorder the occurrence of which depends on the interaction of the effects of many genes or gene combinations as well environmental factors. This review presents novel recommendations concerning hypertension treatment of chronic kidney disease patients, including ACE inhibitor (in order to slow down kidney disease progression), angiotensin II receptor blocker therapy, bumetanide, furosemide, calcium antagonist, etc. Moreover, non-pharmacological interventions aiming at reducing blood pressure, such as diet and lifestyle change and renal denervation, are described herein. Finally, we presented novel, emerging strategies including neprilysin and sacubitril/valsartan (LCZ696).

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“…108 These beneficial effects were seen irrespective of concomitant treatment with mineralocorticoid-receptor antagonists (MRAs) or ACE inhibtors. 109,110 In the phase III ALTITUDE trial, 111 8,561 patients with type 2 diabetes mellitus in addition to chronic kidney disease, cardiovascular disease, or both, were randomly assigned to receive aliskiren or placebo, along with an ACE inhibitor or ARB. The trial was stopped prematurely because of safety concerns and lack of effect of treatment.…”

Section: Aliskirenmentioning

confidence: 99%

New medical therapies for heart failure

Lueder

Krum

2015

Nat Rev Cardiol

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Heart failure (HF) can rightfully be called the epidemic of the 21(st) century. Historically, the only available medical treatment options for HF have been diuretics and digoxin, but the capacity of these agents to alter outcomes has been brought into question by the scrutiny of modern clinical trials. In the past 4 decades, neurohormonal blockers have been introduced into clinical practice, leading to marked reductions in morbidity and mortality in chronic HF with reduced left ventricular ejection fraction (LVEF). Despite these major advances in pharmacotherapy, our understanding of the underlying disease mechanisms of HF from epidemiological, clinical, pathophysiological, molecular, and genetic standpoints remains incomplete. This knowledge gap is particularly evident with respect to acute decompensated HF and HF with normal (preserved) LVEF. For these clinical phenotypes, no drug has been shown to reduce long-term clinical event rates substantially. Ongoing developments in the pharmacotherapy of HF are likely to challenge our current best-practice algorithms. Novel agents for HF therapy include dual-acting neurohormonal modulators, contractility-enhancing agents, vasoactive and anti-inflammatory peptides, and myocardial protectants. These novel compounds have the potential to enhance our armamentarium of HF therapeutics.

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Effect of Aliskiren in Patients with Heart Failure According to Background Dose of ACE Inhibitor: A Retrospective Analysis of the Aliskiren Observation of Heart Failure Treatment (ALOFT) Trial

Abstract: Aliskiren causes neurohumoral suppression in heart failure, even in patients treated with ≥recommended-dose of ACE inhibitor.

Cited by 9 publications

References 17 publications

Does Aliskiren Influence the Changes of Global Longitudinal Strain in Patients with Diastolic Dysfunction?

Does Aliskiren Influence the Changes of Global Longitudinal Strain in Patients with Diastolic Dysfunction?

Novel strategies of hypertension management in chronic kidney disease

New medical therapies for heart failure

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