Key result
Aliskiren/amlodipine was significantly more effective than aliskiren/HCTZ in reducing systolic BP (WMD -3.36 mm Hg; 95% CI -4.64 to 2.07) and increasing therapeutic response (RR 1.23).
Why the study?
Does aliskiren/amlodipine improve blood pressure reduction and control compared to aliskiren/HCTZ in patients with hypertension?
Meta-Analysis (n=13,614)
Does aliskiren/amlodipine improve blood pressure reduction and control compared to aliskiren/HCTZ in patients with hypertension?
Mean Difference: -3.36 (95% CI -4.64–2.07)
In an indirect meta-analysis, aliskiren combined with amlodipine provided superior blood pressure reduction and control compared to aliskiren combined with hydrochlorothiazide in patients with hypertension.
Aliskiren/amlodipine may improve BP control over aliskiren/HCTZ; leaves open need for direct head-to-head RCTs.
BACKGROUND: Aliskiren, a direct renin inhibitor, is effective for reducing blood pressure (BP) in patients with hypertension when combined with amlodipine or hydrochlorothiazide (HCTZ). However, the efficacy and tolerability of the 2 combinations are unclear. We performed a meta-analysis of randomized controlled trials of aliskiren/amlodpine and aliskiren/HCTZ for hypertension. METHODS: The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and the Novartis clinical trial database were searched through December 2012 for reports of randomized controlled trials of aliskiren/amlodpine and aliskiren/HCTZ vs. monotherapy in patients with hypertension. The main outcome measures were reduction in systolic BP and diastolic BP from baseline and rates of therapeutic response and BP control. Tolerance of aliskiren/amlodipine and aliskiren/HCTZ was also analyzed. Outcomes were initially pooled by standard random-effects methods, producing a weighted mean difference (WMD) or risk ratio (RR) and 95% confidence intervals (CIs). The pooled estimates were then used for adjusted indirect comparisons. RESULTS: We selected 19 reports of trials involving 13,614 participants. Aliskiren/amlodpine and aliskiren/HCTZ were more effective than monotherapy in controlling BP. Aliskiren/amlodipine was significantly more effective than aliskiren/HCTZ in reducing systolic BP (WMD = -3.36 mm Hg; 95% CI = -4.64 to 2.07 mm Hg) and diastolic BP (WMD = -3.49 mm Hg; 95% CI = -4.34 to 2.63 mm Hg). As compared with aliskiren/HCTZ, alikiren/amlodipine was associated with higher rate of therapeutic response (RR = 1.23; 95% CI = 1.14-1.33) and BP control (RR = 1.24; 95% CI = 1.11-1.39). Number of adverse events and withdrawals due to adverse events were similar with aliskiren/amlodipine and aliskiren/HCTZ. CONCLUSIONS: BP control is better with aliskiren combined with amlodipine or HCTZ than with monotherapy, with aliskiren/amlodipine being more effective than aliskiren/HCTZ.
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Liu et al. (2013) conducted a meta-analysis in Hypertension (n=13,614). Aliskiren/amlodipine vs. Aliskiren/hydrochlorothiazide was evaluated on reduction in systolic BP from baseline (WMD -3.36, 95% CI -4.64 to 2.07). Aliskiren/amlodipine was significantly more effective than aliskiren/HCTZ in reducing systolic BP (WMD -3.36 mm Hg; 95% CI -4.64 to 2.07) and increasing therapeutic response (RR 1.23).
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