Key result
Aliskiren provided a significant difference in systolic blood pressure compared to ramipril at 6 months (MD 3.15 mmHg; 95% CI 2.13-4.17) in non-elderly hypertensive patients.
Why the study?
Ramipril is an established option for hypertension management, but the clinical role of aliskiren remains debated.
Does aliskiren improve systolic and diastolic blood pressure compared to ramipril in patients with mild to moderate hypertension?
Meta-Analysis (n=1,022)
Does aliskiren improve systolic and diastolic blood pressure compared to ramipril in patients with mild to moderate hypertension?
Aliskiren provides a slight short-term improvement in blood pressure compared to ramipril in non-elderly hypertensive patients without diabetes or previous cardiovascular disease.
Aliskiren may support modest short-term SBP lowering over ramipril in non-elderly hypertensives; extends meta-analytic comparisons of renin versus ACE inhibition.
Objective Ramipril is an important option in the management of hypertension, while the role of aliskiren is still up for debate. We aim to meta-analyse and compare the effect of aliskiren with ramipril by measuring mean difference in systolic blood pressure (mdSBP) and mean difference in diastolic blood pressure (mdDBP). Methods The search was conducted using the PubMed and Cochrane databases for eligible randomized clinical trials (RCTs) to perform a meta-analysis from January 2000 to May 2024. RCTs that included hypertensive patients who were under either aliskiren or ramipril treatment were included in the analysis. The risk of bias was evaluated using RoB 2.0. This study is registered with PROSPERO: CRD42024577105. Results Four studies were included: two studies were carried out for 2 months, and two were carried out for 6 months, including 693 and 329 patients, respectively, with mild to moderate hypertension and a mean age of 55.2 years. After 2 months, mdDBP was found to be significant (mdDBP = 0.85 mmHg, 95% CI: 0.73–0.97, I 2 = 0%), but mdSBP was found to be non-significant (mdSBP = 0.0 mmHg, 95% CI: −0.17–0.17, I 2 = 0%). There was a significant difference in the mdSBP (mdSBP = 3.15 mmHg, 95% CI: 2.13–4.17, I 2 = 84%) and mdDBP (mdDBP = 1.2 mmHg, 95% CI: 1.09–1.31, I 2 = 0%) at 6 months. Conclusion Aliskiren provides, in the short term, a slight improvement in BP in non-elderly hypertensive patients without diabetes or previous cardio-cerebrovascular disease.
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Alam et al. (2024) conducted a meta-analysis in mild to moderate hypertension (n=1,022). Aliskiren vs. Ramipril was evaluated on mean difference in systolic blood pressure at 6 months (MD 3.15, 95% CI 2.13-4.17). Aliskiren provided a significant difference in systolic blood pressure compared to ramipril at 6 months (MD 3.15 mmHg; 95% CI 2.13-4.17) in non-elderly hypertensive patients.
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