Key result
Aliskiren/HCTZ lowers systolic BP by ~7 mm Hg more than HCTZ monotherapy at week 4.
Why the study?
Patients with stage 2 systolic hypertension require sizable blood pressure reductions to achieve recommended targets, prompting comparison of single-pill aliskiren/HCTZ combination therapy with HCTZ monotherapy in older patients.
Does single-pill aliskiren/hydrochlorothiazide combination therapy provide greater blood pressure reductions than hydrochlorothiazide monotherapy in older patients with stage 2 systolic hypertension?
RCT (n=451)
Double-blind
randomized
Does single-pill aliskiren/hydrochlorothiazide combination therapy provide greater blood pressure reductions than hydrochlorothiazide monotherapy in older patients with stage 2 systolic hypertension?
Single-pill aliskiren/HCTZ combination therapy provides significantly greater blood pressure reductions and higher target achievement rates than HCTZ monotherapy in older patients with stage 2 systolic hypertension.
Answers are grounded in this paper and cite their sources.
Aliskiren/HCTZ superior to HCTZ monotherapy for BP reduction and control in older stage 2 systolic hypertension patients; extends support for initial combination therapy.
Patients with stage 2 systolic hypertension require sizable blood pressure (BP) reductions to achieve recommended targets. This randomized double-blind study compared a single-pill combination of the direct renin inhibitor aliskiren and hydrochlorothiazide (aliskiren/HCTZ) with HCTZ monotherapy in older patients (older than 55 years) with systolic BP ≥160 mm Hg and <200 mm Hg. After a 1- to 4-week washout, 451 patients were randomized to once-daily aliskiren/HCTZ 150/12.5 mg or HCTZ 12.5 mg for 1 week, and then double the doses for 7 weeks. Overall baseline BP was 168.8/91.4 mm Hg. At week 4 (primary) end point, aliskiren/HCTZ provided significantly greater BP reductions from baseline than HCTZ monotherapy (29.6/9.3 mm Hg vs 22.3/6.8 mm Hg) and resulted in a greater proportion of patients achieving BP goal of <140/90 mm Hg (51.1% vs 33.3%). Aliskiren/HCTZ therapy provides substantial BP reductions and may thus be a useful treatment option for older patients with stage 2 hypertension.
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Basile et al. (2011) conducted an RCT in Stage 2 systolic hypertension (n=451). Aliskiren/hydrochlorothiazide single-pill combination vs. Hydrochlorothiazide monotherapy 12.5 mg once daily for 1 week, then double the dose (25 mg) for 7 weeks was evaluated on Blood pressure reduction from baseline at week 4. Aliskiren/HCTZ achieved greater week 4 BP reductions than HCTZ alone (29.6/9.3 vs 22.3/6.8 mm Hg) and higher BP control <140/90 mm Hg (51.1% vs 33.3%).
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