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Aliskiren therapy in hypertension and cardiovascular disease: a systematic review and a meta-analysis

Shufang Fu1,2, Xin Wen3, Fei Han4

  • 1Medical Center of The Graduate School, Nanchang University, Nanchang, China.

Oncotarget
|November 29, 2017
PubMed

Insights

Aliskiren combination therapy with ACE inhibitors (ACEIs) or ARBs effectively lowers blood pressure but increases risks of hyperkalemia and kidney injury. This combination therapy showed no benefit in preventing major cardiovascular events compared to monotherapy.

Area of Science:

  • Cardiology
  • Pharmacology
  • Nephrology

Background:

  • Hypertension and cardiovascular disease management often involves combination therapies.
  • Aliskiren, an angiotensin-converting enzyme inhibitor (ACEI), is used in hypertension treatment.
  • The safety and efficacy of combining aliskiren with ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) require thorough investigation.

Purpose of the Study:

  • To evaluate the efficacy and safety of aliskiren combination therapy with ACEIs or ARBs in patients with hypertension and cardiovascular disease.
  • To compare the effects of combined therapy versus monotherapy on blood pressure, kidney injury, hyperkalemia, and major cardiovascular events.

Main Methods:

  • A systematic review and meta-analysis of 13 randomized controlled trials (RCTs) involving 12,222 patients.
  • Literature search conducted across major databases including Cochrane Central Register, Clinical Trials Registry, EMBASE, MEDLINE, and PubMed up to January 2017.
  • Analysis of combined results to determine weighted mean differences (WMD) and relative risks (RR) with 95% confidence intervals (CI).

Main Results:

  • Combination therapy significantly reduced systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared to ACEI/ARB monotherapy.
  • A significant increase in the risk of hyperkalemia (RR, 1.45) and kidney injury (RR, 1.92) was observed with combination therapy.
  • No significant difference in the incidence of major cardiovascular events was found between the combined therapy and monotherapy groups (RR, 0.95).

Conclusions:

  • Aliskiren in combination with ACEIs/ARBs effectively controls blood pressure in hypertensive patients.
  • This combination therapy is associated with increased risks of hyperkalemia and kidney injury.
  • The combined therapy does not offer additional benefits in preventing major cardiovascular events when compared to ACEI or ARB monotherapy.

Keywords:
aliskirencardiovascular diseasehyperkalaemiakidney injury

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