Key result
Aliskiren/hydrochlorothiazide combinations significantly reduced systolic and diastolic blood pressure (up to -16.9/-11.6 mmHg for the 300/25 mg dose) and improved blood pressure control rates compared to monotherapy or placebo.
Why the study?
Does aliskiren/hydrochlorothiazide combination therapy reduce blood pressure and improve control rates in patients with mild or moderate essential hypertension compared to placebo or monotherapy?
Meta-Analysis (n=5,508)
Double-blind
Randomized
Yes
Does aliskiren/hydrochlorothiazide combination therapy reduce blood pressure and improve control rates in patients with mild or moderate essential hypertension compared to placebo or monotherapy?
Effect estimate: SBP/DBP reduction of -16.9/-11.6 mmHg for the 300/25 mg dose
p-value: p=<0.05
Aliskiren/hydrochlorothiazide combination therapy provides significantly greater blood pressure reductions and control rates compared to either drug as monotherapy or placebo in patients with mild to moderate hypertension.
Aliskiren/HCTZ combinations may be prioritized for greater BP control in mild-moderate hypertension; meta-analysis reinforces additive benefit over monotherapy.
BACKGROUND: Single-pill combinations of aliskiren/hydrochlorothiazide have recently been approved by the European Medicines Agency for the treatment of hypertension. OBJECTIVE: This study aimed to assess the antihypertensive efficacy of aliskiren/hydrochlorothiazide combination in reducing systolic and diastolic blood pressure in hypertensive patients. METHODS: A search in International Pharmaceutical Abstracts, MEDLINE, The Cochrane Library and ISI Web of Knowledge was performed from 2000 to November 2009, to identify randomized, double-blind, clinical trials using aliskiren/hydrochlorothiazide for the treatment of hypertension. Studies were included if they evaluated the antihypertensive efficacy of aliskiren/hydrochlorothiazide in patients with mild or moderate essential hypertension and age ≥ 18 years. The meta-analytical approach calculated the weighted average reductions of systolic and diastolic blood pressure for each daily dosage combination. RESULTS: We included 5 clinical trials testing several combinations of aliskiren/hydrochlorothiazide and containing data on 5448 patients. In all studies blood pressure was assessed at inclusion (baseline) and after 8 weeks of therapy. Blood pressure reductions and control rates were significantly (p < 0.05) higher with the aliskiren/hydrochlorothiazide combinations than with placebo and the same doses of aliskiren or hydrochlorothiazide alone. The weighted mean reductions (mm Hg) from baseline of systolic and diastolic blood pressure for each aliskiren/hydrochlorothiazide combination were: -15.8/-10.3 (150/25 mg); -15.9/-11.8 (300/12.5 mg); -16.9/-11.6 (300/25 mg). Blood pressure control rates (%) for the above combinations were, at least, respectively: 43.8, 50.1 and 51.9. CONCLUSIONS: Aliskiren/hydrochlorothiazide provided clinically significant additional blood pressure reductions and improved blood pressure control rates over aliskiren or hydrochlorothiazide monotherapy.
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Manuel Morgado (2011) conducted a meta-analysis in Mild to moderate essential hypertension (n=5,508). Aliskiren/Hydrochlorothiazide vs. Placebo, aliskiren monotherapy, or hydrochlorothiazide monotherapy was evaluated on Weighted mean reduction in systolic and diastolic blood pressure from baseline (SBP/DBP reduction of -16.9/-11.6 mmHg for the 300/25 mg dose, p=<0.05). Aliskiren/hydrochlorothiazide combinations significantly reduced systolic and diastolic blood pressure (up to -16.9/-11.6 mmHg for the 300/25 mg dose) and improved blood pressure control rates compared to monotherapy or placebo.
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