Key result
Addition of aliskiren to amlodipine significantly improved flow-mediated vasodilation from 2.6% to 3.7% (P=0.001) in elderly hypertensive patients, whereas high-dose amlodipine monotherapy did not.
Why the study?
Does aliskiren/amlodipine combination therapy improve endothelial function compared to high-dose amlodipine monotherapy in elderly hypertensive patients?
RCT (n=105)
Does aliskiren/amlodipine combination therapy improve endothelial function compared to high-dose amlodipine monotherapy in elderly hypertensive patients?
p-value: p=0.001
The addition of aliskiren to amlodipine improves endothelial function in elderly hypertensive patients compared to up-titrating amlodipine to a high dose.
Aliskiren add-on may enhance endothelial function in elderly hypertensives on amlodipine; extends combination data beyond BP lowering.
BACKGROUND: The aim of this study was to compare the effects of direct renin inhibitor, aliskiren, and amlodipine combination therapy with those of high-dose amlodipine monotherapy on endothelial function in elderly hypertensive patients. METHODS: Participants included 105 patients (mean age 77 years) who had receive 5mg amlodipine for 4 weeks. Patients were allocated to the aliskiren/amlodipine group (AL/AM) or the high-dose amlodipine (AM) group. The AL/AM group received 150mg aliskiren in addition to 5mg amlodipine for 8 weeks; then the dose of aliskiren was doubled to 300mg for another 8 weeks. The AM group received 10mg amlodipine for 16 weeks. Of the 105 patients, 87 who underwent measurements of brachial flow-mediated vasodilation (FMD) and nitroglycerin-mediated vasodilation (NMD) before and after the study were included in the analysis. RESULTS: Blood pressure-lowering effects were similar in the 2 groups. Plasma renin activity significantly decreased in the AL/AM group (P < 0.001) but increased in the AM group (P < 0.001). Improvement of FMD was found in the AL/AM group (2.6% to 3.7%, P = 0.001) but not in the AM group, while NMD did not change in either group. The changes in 24-hour systolic blood pressure (r = -0.60, P < 0.001) and diastolic blood pressure (r = -0.46, P = 0.004) were significantly correlated with improvement of FMD in the AL/AM group but not in the AM group. CONCLUSION: Addition of aliskiren improved endothelial function in elderly hypertensive patients treated with amlodipine. CLINICAL TRIAL REGISTRY NUMBER: UMIN000010163.
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Fukutomi et al. (2013) conducted an RCT in Hypertension (n=105). Aliskiren/amlodipine combination vs. High-dose amlodipine (10mg for 16 weeks) was evaluated on brachial flow-mediated vasodilation (FMD) (p=0.001). Addition of aliskiren to amlodipine significantly improved flow-mediated vasodilation from 2.6% to 3.7% (P=0.001) in elderly hypertensive patients, whereas high-dose amlodipine monotherapy did not.
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