First-Line Aliskiren/Hydrochlorothiazide Combination Therapy Lowers Blood Pressure More Effectively Than Hydrochlorothiazide Alone in Obese Older Patients With Stage 2 Hypertension: PP.34.376

Aliskiren-based stepped-care treatment algorithm provides effective blood pressure control

“…Combining HCTZ with aliskiren improved BP reduction from −9.1/−5.2 mmHg with aliskiren monotherapy to −15.6/−6.6 mmHg with the combination therapy. Previous studies have demonstrated that aliskiren/HCTZ is more effective than aliskiren, HCTZ, amlodipine or ramipril monotherapies in reducing BP in patients who are difficult‐to‐treat, including patients with Stage 2 hypertension and with concomitant diabetes or obesity (40–42). These results are also consistent with the findings from previous studies that showed increased BP reduction when other RAAS blockers were combined with HCTZ compared with either agent as monotherapy (43–46).…”

“…Previous studies have demonstrated that aliskiren ⁄ HCTZ is more effective than aliskiren, HCTZ, amlodipine or ramipril monotherapies in reducing BP in patients who are difficult-to-treat, including patients with Stage 2 hypertension and PRA, plasma renin activity; ALI, aliskiren; HCTZ, hydrochlorothiazide; AML, amlodipine; CI, confidence interval. with concomitant diabetes or obesity (40)(41)(42). These results are also consistent with the findings from previous studies that showed increased BP reduction when other RAAS blockers were combined with HCTZ compared with either agent as monotherapy (43)(44)(45)(46).…”

Pharmacokinetics and Pharmacodynamics of Aliskiren/Hydrochlorothiazide Single‐Pill Combination Tablets and Free Combination of Aliskiren and Hydrochlorothiazide

“…We compared the effects of aliskiren/HCT 300/25‐mg SPC tablets and the free combination of aliskiren 300‐mg and HCT 25‐mg tablets on changes in PRA in the subgroup of patients with biomarker measurements from 2 previously published 8‐week, randomized, double‐blind studies conducted in patients with hypertension. Study IV (aliskiren/HCT 300/25‐mg SPC tablet) enrolled patients ≥55 years of age with stage 2 systolic hypertension (baseline mean sitting systolic BP [msSBP] between 160 and 200 mm Hg) 17 . Study V (aliskiren 300‐mg and HCT 25‐mg free combination) enrolled patients ≥18 years of age with mild to moderate hypertension (baseline mean sitting diastolic BP [msDBP] between 95 and 110 mm Hg) 15 .…”

“…Unlike other RAS inhibitors (angiotensin‐converting enzyme [ACE] inhibitors and angiotensin receptor blockers [ARBs]), aliskiren targets the RAS at the rate‐limiting step by directly inhibiting renin and thereby reducing PRA 13 , 14 . Clinical studies involving patients with hypertension have shown that combinations of aliskiren with HCT provide clinically significant additional BP reductions compared with the respective monotherapies 15 – 17 and improve BP control rates in patients who have not responded to aliskiren or HCT monotherapy 18 , 19 . Longer term studies (6–12 months) have shown that aliskiren‐based therapy (with optional addition of HCT to achieve BP control) is well tolerated 20 and lowers BP more effectively than ACE inhibitor (ramipril)/HCT‐based therapy 21 …”

Role of aliskiren in blood pressure control and renoprotection

“…In patients with stage 1 to stage 2 hypertension, combined strategies of aliskiren plus hydrochlorothiazide were more effective than aliskiren, hydrochlorothiazide, or ramipril monotherapies, and at least as effective as amlodipine, in reducing blood pressure in patients with stage 2 hypertension, including patients with diabetes, patients with obesity, patients with metabolic syndrome, African American patients, and aged patients. [78][79][80][81][82][83] Patients who received aliskiren plus valsartan had significantly greater blood pressure reductions than with either an individual component or placebo. 84 The antihypertensive effect of the combination of aliskiren plus valsartan was similar in patients with or without diabetes.…”