Key result
Aliskiren/hydrochlorothiazide matches amlodipine for systolic blood pressure reduction in African American patients with hypertension.
Why the study?
Does combination aliskiren/hydrochlorothiazide reduce mean sitting systolic blood pressure more effectively than amlodipine monotherapy in African American patients with stage 2 hypertension?
RCT (n=332)
Double-blind, double-dummy
1:1 ratio
Yes
Does combination aliskiren/hydrochlorothiazide reduce mean sitting systolic blood pressure more effectively than amlodipine monotherapy in African American patients with stage 2 hypertension?
Mean Difference: -0.42 (95% CI -3.8–2.9)
Absolute Event Rate: -28.61% vs -28.18%
p-value: p=0.8
In African Americans with stage 2 hypertension, combination aliskiren/HCTZ lowers brachial blood pressure similarly to amlodipine but may offer greater central aortic pressure reductions.
Aliskiren/HCTZ matches amlodipine for brachial SBP reduction in African American stage 2 hypertension; confirms comparable primary efficacy in this RCT.
Efficacy of antihypertensive agents on central blood pressure (BP) in African Americans is not well studied. The authors report on an 8-week double-blind, randomized study of African American patients with stage 2 hypertension that compared brachial and central BP responses (substudy of 53 patients) to combination aliskiren/hydrochlorthiazide (HCTZ) and amlodipine monotherapy. Following a 1- to 4-week washout, initial therapy was aliskiren/HCTZ 150/12.5 mg (n=166) or amlodipine 5 mg (n=166) for 1 week, forced-titrated to aliskiren/HCTZ 300/25 mg or amlodipine 10 mg for 7 weeks. Mean seated systolic BP reductions from baseline was similar with both treatments (-28.6 mm Hg with aliskiren/HCTZ vs -28.2 mm Hg with amlodipine). In the substudy, significantly greater reductions in central systolic BP was observed with aliskiren/HCTZ vs amlodipine (-30.1 mm Hg vs -21.2; P=.031), although 24-hour mean ambulatory BP reductions between the two groups were similar. Central pressure is considered an important risk factor in African Americans, and these findings may suggest a new treatment option for these patients.
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Ferdinand et al. (2011) conducted an RCT in Stage 2 Hypertension (n=332). Aliskiren/Hydrochlorothiazide vs. Amlodipine 5 mg forced-titrated to 10 mg daily was evaluated on Change in mean sitting systolic blood pressure (MSSBP) from baseline at week 8 (LS mean difference -0.42 mm Hg, 95% CI -3.8 to 2.9, p=0.8). Combination aliskiren/hydrochlorothiazide and amlodipine monotherapy reduced mean sitting systolic blood pressure similarly (MD -0.42 mm Hg, p=0.8) in African American patients with stage 2 hypertension.
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