Aliskiren vs. angiotensin receptor blockers in hypertension: meta-analysis of randomized controlled trials

Aliskiren, a newly discovered renin inhibitor, blocks the renin-angiotensin system (RAS) from the top of the enzyme cascade and therefore, might provide comparable or even superior clinical efficacy of blood pressure (BP) control than angiotensin receptor blockers (ARBs). With this meta-analysis, we aimed to compare the efficacy and tolerability of aliskiren and ARBs in the treatment of hypertension in the short-term treatment period.

Reports of randomized controlled trials (RCTs) comparing aliskiren and ARBs in patients with hypertension were selected by a search of the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. The main outcome measures were reduction in diastolic BP (DBP) and systolic BP (SBP) and rates of therapeutic response and BP control. We also compared the tolerability of aliskiren and ARBs. Revman v5.0 was used to obtain the pooled estimates.

We analyzed data from 10 reports of trials involving 3,732 participants. DBP and SBP reduction did not differ between aliskiren and ARBs (weighted mean difference (WMD), -0.18; 95% confidence interval (CI), -1.07 to 0.71, and WMD, 0.15; 95% CI, -1.38 to 1.69, respectively). Aliskiren and ARB treatment did not differ in rates of BP control or therapeutic response. Moreover, aliskiren and ARB treatment led to a similar number of adverse events, severe adverse events, and withdrawal due to adverse events.

Aliskiren is as effective as ARBs (losartan, valsartan, and irbesartan) in controlling BP and does not differ from ARBs in risk of adverse events.