Key result
Aliskiren shows no benefit over ARBs for lowering ambulatory blood pressure in hypertensive CKD.
Why the study?
The comparative effects of direct renin inhibitor versus angiotensin II receptor blockers on clinic and ambulatory blood pressure profiles in hypertensive CKD patients were unclear.
Does aliskiren improve clinic and ambulatory blood pressure compared to ARBs in patients with hypertension and chronic kidney disease?
RCT (n=36)
Does aliskiren improve clinic and ambulatory blood pressure compared to ARBs in patients with hypertension and chronic kidney disease?
Aliskiren is not superior to ARBs in lowering ambulatory blood pressure in patients with hypertension and chronic kidney disease, despite comparable effects on clinic blood pressure.
Aliskiren should not supplant ARBs for ambulatory BP control in hypertensive CKD; hypothesis-generating for clinic-ambulatory discordance in prospective trials.
We compared the therapeutic effects of aliskiren (direct renin inhibitor (DRI) group) with angiotensin II (Ang II) type 1 receptor blockers (ARBs) (ARB group) on clinic blood pressure (BP) and ambulatory BP in 36 hypertensive chronic kidney disease (CKD) patients. The baseline clinic BP levels and the after-treatment/baseline (A/B) ratios of clinic BP levels, estimated after 24-week treatment period, were similar in DRI group (n = 18) and ARB group (n = 18). With respect to the effects on ambulatory BP, the A/B ratios of the daytime and nighttime systolic BP in DRI group were significantly higher than those in ARB group. The A/B ratio of ankle-brachial pressure index after the study was higher in the DRI group compared with the ARB group. The results of the present study suggest that DRI therapy is not superior to ARB therapy in lowering ambulatory BP in hypertensive CKD patients, in spite of comparable clinic BP-lowering effects.
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Uneda et al. (2016) conducted an RCT in Hypertension with chronic kidney disease (n=36). Aliskiren (direct renin inhibitor) vs. Angiotensin II type 1 receptor blockers (ARBs) was evaluated on Clinic and ambulatory blood pressure profiles. Aliskiren was not superior to ARB therapy in lowering ambulatory blood pressure in hypertensive CKD patients, despite comparable clinic blood pressure-lowering effects.
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