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Comparable effect of aliskiren or a diuretic added on an angiotensin II receptor blocker on augmentation index in hypertension: a multicentre, prospective, randomised study

View Article: PubMed Central - PubMed

ABSTRACT

Background: The effects of antihypertensive drug combination therapy on central blood pressure (BP) and augmentation index (AI) have not been fully elucidated. We investigated the effects of the direct renin inhibitor, aliskiren, or a diuretic added to an angiotensin II receptor blocker on AI in patients with essential hypertension.

Methods: A 24-week, prospective, multicentre, randomised, open-label study enrolled 103 patients already treated with valsartan. Participants were randomly allocated to receive either valsartan with aliskiren (V+A), or valsartan with trichlormethiazide (V+T). The primary outcome was the change in AI derived from radial artery tonometry. Secondary outcome measures included systolic and diastolic BP, cardio-ankle vascular index (CAVI, which reflects arterial stiffness) and urinary 8-hydroxydeoxyguanosine concentration.

Results: After 24 weeks, systolic and diastolic BP were significantly reduced in both groups to a broadly comparable extent. There was no significant difference in AI at the end of the study between the V+A group and the V+T group (between-group difference: −2.3%, 95% CI −6.9% to 2.2%, p=0.31). Central BP at the end of the study also did not differ between the two groups (p=0.62). There was no significant difference in the CAVI between the groups at the end of the study. Urinary 8-hydroxydeoxyguanosine concentration was significantly lower in the V+A group than in the V+T group (p<0.01), suggesting that V+A attenuated oxidative stress more than V+T.

Conclusion: The combination of valsartan and aliskiren had an effect on AI comparable with that of the combination of valsartan and trichlormethiazide.

Umin clinical trial registration number: UMIN000005726.

No MeSH data available.


Patient distribution. A total of 103 participants were randomised into the V+A and V+T groups, but the data of 97 were subject to final analysis (48 in the V+A group and 49 in the V+T group). V+A, valsartan with aliskiren; V+T, valsartan with trichlormethiazide.
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Figure 2: Patient distribution. A total of 103 participants were randomised into the V+A and V+T groups, but the data of 97 were subject to final analysis (48 in the V+A group and 49 in the V+T group). V+A, valsartan with aliskiren; V+T, valsartan with trichlormethiazide.

Mentions: We randomised 103 participants to the V+A and V+T groups (figure 2), but the data of 97 were subject to final analysis (48 in the V+A group and 49 in the V+T group). There were no significant differences in age, sex, height, body mass index, smoking status or baseline drug regime of each group (table 1). Patients with chronic kidney disease comprised 60% of the V+A group and 59% of the V+T group. The mean eGFR in the V+A group and the V+T group was 56.3±13.2 mL/min/1.73 m2 and 57.8±18.0 mL/min/1.73 m2, respectively. The mean final doses of aliskiren and trichlormethiazide were 198.8±71.1 mg/day and 1.5±0.7 mg/day, respectively.


Comparable effect of aliskiren or a diuretic added on an angiotensin II receptor blocker on augmentation index in hypertension: a multicentre, prospective, randomised study
Patient distribution. A total of 103 participants were randomised into the V+A and V+T groups, but the data of 97 were subject to final analysis (48 in the V+A group and 49 in the V+T group). V+A, valsartan with aliskiren; V+T, valsartan with trichlormethiazide.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5384463&req=5

Figure 2: Patient distribution. A total of 103 participants were randomised into the V+A and V+T groups, but the data of 97 were subject to final analysis (48 in the V+A group and 49 in the V+T group). V+A, valsartan with aliskiren; V+T, valsartan with trichlormethiazide.
Mentions: We randomised 103 participants to the V+A and V+T groups (figure 2), but the data of 97 were subject to final analysis (48 in the V+A group and 49 in the V+T group). There were no significant differences in age, sex, height, body mass index, smoking status or baseline drug regime of each group (table 1). Patients with chronic kidney disease comprised 60% of the V+A group and 59% of the V+T group. The mean eGFR in the V+A group and the V+T group was 56.3±13.2 mL/min/1.73 m2 and 57.8±18.0 mL/min/1.73 m2, respectively. The mean final doses of aliskiren and trichlormethiazide were 198.8±71.1 mg/day and 1.5±0.7 mg/day, respectively.

View Article: PubMed Central - PubMed

ABSTRACT

Background: The effects of antihypertensive drug combination therapy on central blood pressure (BP) and augmentation index (AI) have not been fully elucidated. We investigated the effects of the direct renin inhibitor, aliskiren, or a diuretic added to an angiotensin II receptor blocker on AI in patients with essential hypertension.

Methods: A 24-week, prospective, multicentre, randomised, open-label study enrolled 103 patients already treated with valsartan. Participants were randomly allocated to receive either valsartan with aliskiren (V+A), or valsartan with trichlormethiazide (V+T). The primary outcome was the change in AI derived from radial artery tonometry. Secondary outcome measures included systolic and diastolic BP, cardio-ankle vascular index (CAVI, which reflects arterial stiffness) and urinary 8-hydroxydeoxyguanosine concentration.

Results: After 24 weeks, systolic and diastolic BP were significantly reduced in both groups to a broadly comparable extent. There was no significant difference in AI at the end of the study between the V+A group and the V+T group (between-group difference: −2.3%, 95% CI −6.9% to 2.2%, p=0.31). Central BP at the end of the study also did not differ between the two groups (p=0.62). There was no significant difference in the CAVI between the groups at the end of the study. Urinary 8-hydroxydeoxyguanosine concentration was significantly lower in the V+A group than in the V+T group (p<0.01), suggesting that V+A attenuated oxidative stress more than V+T.

Conclusion: The combination of valsartan and aliskiren had an effect on AI comparable with that of the combination of valsartan and trichlormethiazide.

Umin clinical trial registration number: UMIN000005726.

No MeSH data available.