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Aliskiren in Patients Failing to Achieve Blood Pressure Targets With Angiotensin Converting Enzyme Inhibitors or
Elizabeth B Hawkins1, Hua Ling2, Tammy L Burns2
1Department of Pharmacy Services, Creighton University Medical Center, Omaha, NE, USA.
Insights
Aliskiren did not effectively lower blood pressure (BP) in patients already using angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB). This study suggests aliskiren has a limited role in managing hypertension for these patients.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Management
Background:
- Many patients struggle to achieve blood pressure (BP) goals with standard treatments like angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB).
- Assessing alternative or add-on therapies is crucial for effective hypertension management.
Purpose of the Study:
- To evaluate the efficacy of aliskiren in patients with uncontrolled hypertension despite ACEI or ARB therapy.
- To compare the blood pressure-lowering effects of aliskiren against maximal ACEI or ARB therapy.
Main Methods:
- A cohort of 107 patients, previously failing to meet BP targets on ACEI or ARB, were switched to aliskiren.
- Blood pressure changes were measured during treatment with maximal doses of ACEI, ARB, or aliskiren.
Main Results:
- Aliskiren at 150 mg/day and 300 mg/day showed mean systolic BP reductions of 6.7 mmHg and 8.6 mmHg, respectively.
- These reductions were comparable to those observed with ACEI (8.5 mmHg) and ARB (8.3 mmHg).
- No statistically significant differences in BP reduction were found between aliskiren, ACEI, and ARB therapies.
Conclusions:
- Aliskiren demonstrated ineffectiveness as a substitute therapy for patients not reaching BP goals with ACEI or ARB.
- Considering restricted combination use with ACEI/ARB, higher costs, and limited outcome data, aliskiren's clinical utility in this patient group is minimal.
Background:
To assess the efficacy of aliskiren in patients failing to reach blood pressure (BP) goals with angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB).
Methods:
A total of 107 patients who failed to reach BP goals on ACEI or ARB were switched to aliskiren. Changes in BP were determined during maximal ACEI, ARB, or aliskiren therapy.
Results:
Mean reduction in sBP and dBP with ACEI was 8.5 ± 6.3 mmHg and 6.0 ± 4.7 mmHg, respectively. Mean reduction in sBP and dBP with ARB was 8.3 ± 6.7 mmHg and 5.0 ± 5.2 mmHg, respectively. Mean reduction in sBP and dBP with aliskiren 150 mg/d was 6.7 ± 5.4 mmHg and 5.4 ± 4.8 mmHg, respectively. Mean reduction in sBP and dBP with aliskiren 300 mg/d was 8.6 ± 6.3 mmHg and 6.0 ± 4.9 mmHg, respectively. BP reductions between ACEI, ARB, and aliskiren were not significantly different.
Conclusions:
Aliskiren is ineffective in patients failing ACEI or ARB therapy. Given the label changes restricting the use of aliskiren in combination with ACEI and ARB, excess cost compared to ACEI and ARB, and a paucity of outcome data, there is a limited role for aliskiren in practice.
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