Effects of Direct Renin Blockade on Renal & Systemic Hemodynamics and on RAAS Activity, in Weight Excess and Hypertension: A Randomized Clinical Trial
Key result
In men with weight excess and hypertension, direct renin inhibition with aliskiren significantly increased effective renal plasma flow from 301 to 320 mL/min/1.73m2 and reduced mean arterial pressure compared to baseline.
Why the study?
Does direct renin inhibition with aliskiren improve renal and systemic hemodynamics and reduce RAAS activity compared to ACE inhibition with ramipril in men with weight excess and hypertension?
Population
15 men with weight excess and hypertension
Comparison
Aliskiren 300 mg/day vs Ramipril 10 mg/day (positive control)
Design
RCT, randomized, cross-over, double-blind
Authors
Discussion
Loading...
Member takes
Overview
Aliskiren improves renal hemodynamics in obese hypertensive men; extends ACEI comparisons by showing distinct renal effects.
Study Design
Type
RCT (n=15)
Blinding
Double-blind
Randomization
1:1 cross-over
Multicenter
No
Structured PICO
Does direct renin inhibition with aliskiren improve renal and systemic hemodynamics and reduce RAAS activity compared to ACE inhibition with ramipril in men with weight excess and hypertension?
P
Population
15 Caucasian men with weight excess and essential hypertension, normal renal function, and normo- or microalbuminuria, who completed two 6-week treatment periods in a cross-over design.
I
Intervention
Aliskiren 300 mg/day
C
Comparator
Ramipril 10 mg/day (positive control)
O
Outcome
Renal and systemic hemodynamics, and RAAS activitysurrogate
Main Result
Absolute Event Rate: 320% vs 301%
p-value: p=0.012
In men with weight excess and hypertension, direct renin inhibition with aliskiren improved renal and systemic hemodynamics and reduced albuminuria, showing some distinct renal hemodynamic effects compared to ACE inhibition.
Limitations
- Studied effects during liberal sodium intake, which may underestimate efficacy
- Small sample size
- Included only men, limiting generalizability
- No control group of healthy subjects to compare renal response
Cite This Study
Kwakernaak et al. (2017) conducted an RCT in Weight excess and essential hypertension (n=15). Direct renin blockade (aliskiren) vs. Baseline and ACE inhibition (ramipril 10 mg/day) was evaluated on Effective renal plasma flow (ERPF) in mL/min/1.73m2 (p=0.012). In men with weight excess and hypertension, direct renin inhibition with aliskiren significantly increased effective renal plasma flow from 301 to 320 mL/min/1.73m2 and reduced mean arterial pressure compared to baseline.