Key result
Aliskiren reduced systemic vascular resistance by 20.4% compared to a 2.9% increase in controls (p=0.038) in patients with decompensated severe heart failure taking ACE inhibitors.
Why the study?
Does aliskiren improve systemic vascular resistance and cardiac index in patients with decompensated severe heart failure taking ACE inhibitors?
Does aliskiren improve systemic vascular resistance and cardiac index in patients with decompensated severe heart failure taking ACE inhibitors?
Absolute Event Rate: -20.4% vs 2.9%
p-value: p=0.038
Short-term use of the direct renin inhibitor aliskiren significantly reduces systemic vascular resistance in patients with decompensated severe heart failure already on ACE inhibitors.
Aliskiren reduced SVR short-term in decompensated HF on ACEi; leaves open efficacy, safety, and outcomes in larger randomized trials.
AIM: The renin-angiotensin-aldosterone system (RAAS) has dual pathways to angiotensin II production; therefore, multiple blockages may be useful in heart failure. In this study, we evaluated the short-term haemodynamic effects of aliskiren, a direct renin inhibitor, in patients with decompensated severe heart failure who were also taking angiotensin-converting enzyme (ACE) inhibitors. MATERIALS AND METHODS: A total of 16 patients (14 men, two women, mean age: 60.3 years) were enrolled in the study. The inclusion criteria included hospitalisation due to decompensated heart failure, ACE inhibitor use, and an ejection fraction < 40% (mean: 21.9 ± 6.7%). The exclusion criteria were: creatinine > 2.0 mg/dl, cardiac pacemaker, serum K(+) > 5.5 mEq/l, and systolic blood pressure < 70 mmHg. Patients either received 150 mg/d aliskiren for 7 days (aliskiren group, n = 10) or did not receive aliskiren (control group, n = 6). Primary end points were systemic vascular resistance and cardiac index values. Repeated-measures analysis of variance (ANOVA) was used to assess variables before and after intervention. A two-sided p-value < 0.05 was considered statistically significant. RESULTS: Compared to pre-intervention levels, systemic vascular resistance was reduced by 20.4% in aliskiren patients, but it increased by 2.9% in control patients (p = 0.038). The cardiac index was not significantly increased by 19.0% in aliskiren patients, but decreased by 8.4% in control patients (p = 0.127). No differences in the pulmonary capillary or systolic blood pressure values were observed between the groups. CONCLUSION: Aliskiren use reduced systemic vascular resistance in patients with decompensated heart failure taking ACE inhibitors.
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Brancalhao et al. (2011) studied decompensated severe heart failure (n=16). aliskiren vs. no aliskiren was evaluated on systemic vascular resistance (p=0.038). Aliskiren reduced systemic vascular resistance by 20.4% compared to a 2.9% increase in controls (p=0.038) in patients with decompensated severe heart failure taking ACE inhibitors.
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