Key result
Aliskiren reduces MSNA by ~9 bursts/min vs control in hypertensive CKD patients.
Why the study?
Does aliskiren reduce sympathetic nerve activity and blood pressure in hypertensive Stages 2-4 CKD patients?
RCT (n=20)
Does aliskiren reduce sympathetic nerve activity and blood pressure in hypertensive Stages 2-4 CKD patients?
Mean Difference: -8.9 (95% CI -15–-3)
Absolute Event Rate: -9.6% vs -0.7%
p-value: p=0.005
Aliskiren significantly reduces muscle sympathetic nerve activity and blood pressure in patients with hypertensive chronic kidney disease.
Aliskiren may reduce sympathetic activity in hypertensive CKD; hypothesis-generating and should not yet change practice.
BACKGROUND: Hypertensive chronic kidney disease (CKD) patients often have sympathetic hyperactivity. In this pilot study, we evaluated the effect of 6 weeks treatment with aliskiren on sympathetic activity in hypertensive Stages 2-4 CKD patients. METHODS: In 10 CKD patients (8 males, aged 44 ± 11 years, estimated glomerular filtration rate ( 57 ± 22 mL/min/1.73 m(2)), blood pressure and sympathetic activity [quantified by assessment of muscle sympathetic nerve activity (MSNA)] were assessed, while taken off renin-angiotensin blocker, and during the 6 weeks of treatment with aliskiren 300 mg/day. Ten other CKD patients served as control and were studied twice with an interval of 6 weeks without any change in medication, to quantify within subject reproducibility. RESULTS: In the aliskiren study group, MSNA was reduced from 36 ± 8 to 26 ± 8 bursts/min (P = 0.01). Aliskiren lowered supine systolic and diastolic blood pressure from 147 ± 10 to 120 ± 8 and from 96 ± 7 to 83 ± 7 mmHg, respectively (both P < 0.05). MSNA changed in patients treated with aliskiren [-9.6 bursts/min with 95% confidence interval (CI) -4.0 to -15.0; P-value = 0.003] but not in controls (-0.7 bursts/min with 95% CI -2.2 to 4.0; P-value = 0.6). The mean difference in change between aliskiren group and the control group was -8.9 with 95% CI of -15 to -3; P = 0.005. CONCLUSION: In hypertensive CKD patients, 6 weeks aliskiren treatment lowers blood pressure and MSNA (Clinical trial government identifier number: NCT00719316).
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Siddiqi et al. (2011) conducted an RCT in Hypertensive chronic kidney disease (CKD) Stages 2-4 (n=20). Aliskiren vs. Control (no change in medication) was evaluated on Change in muscle sympathetic nerve activity (MSNA) (MD -8.9, 95% CI -15 to -3, p=0.005). Six weeks of aliskiren treatment significantly reduced muscle sympathetic nerve activity in hypertensive CKD patients compared to control (mean difference -8.9 bursts/min; 95% CI -15 to -3; P=0.005).
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