Key result
Aliskiren at 150 and 300 mg provides antihypertensive efficacy comparable or superior to other agents and has a placebo-like tolerability profile, but is not recommended with ACE-inhibitors or ARBs.
Why the study?
Does aliskiren safely reduce blood pressure and improve clinical endpoints in patients with hypertension?
Systematic Review
Does aliskiren safely reduce blood pressure and improve clinical endpoints in patients with hypertension?
Aliskiren is an effective and well-tolerated once-daily antihypertensive, but dual renin-angiotensin system blockade with ACE inhibitors or ARBs should be avoided in patients with diabetes and renal impairment.
Aliskiren monotherapy is supported for hypertension; confirms prohibition of dual RAS blockade with ACEIs or ARBs.
INTRODUCTION: Aliskiren is the first orally active direct renin inhibitor approved for the treatment of hypertension. Aliskiren's inhibitory effect on angiotensin I generation, through renin blockade, is highly specific and long-lasting (24 hours). This feature differentiates aliskiren from traditional antihypertensive drugs. AREAS COVERED: This paper reviews the results of various clinical trials which investigate the safety and efficacy of aliskiren on blood pressure (BP) reduction and clinical end points. EXPERT OPINION: Aliskiren is suitable for once-daily administration. Its antihypertensive effect is comparable or superior to that of other antihypertensive agents at recommended doses. The tolerability profile of aliskiren is placebo-like at the licensed doses of 150 and 300 mg. In particular, the discontinuation of therapy due to clinical adverse events occurs similarly among patients treated with either aliskiren or placebo. Aliskiren is not recommended in association with ACE-inhibitors or angiotensin II receptor blockers in patients with type 2 diabetes and renal impairment. Pending disclosure of full results, the early termination of the ALTITUDE seems to confirm previous concerns about the safety of the dual pharmacological blockade of the renin-angiotensin system in these patients. Aliskiren is a well-tolerated antihypertensive drug that may help to achieve the recommended targets of BP control.
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Angeli et al. (2012) conducted a systematic review in hypertension. Aliskiren vs. placebo or other antihypertensive agents was evaluated on blood pressure (BP) reduction and clinical end points. Aliskiren at 150 and 300 mg provides antihypertensive efficacy comparable or superior to other agents and has a placebo-like tolerability profile, but is not recommended with ACE-inhibitors or ARBs.
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