There was a dose-dependent decrease in blood pressure for aliskiren 75 mg , 150 mg and 300 mg .
Aliskiren had no effect on blood pressure variability .
Due to very limited information available regarding change in heart rate and pulse pressure , it was not possible to meta-analyze these outcomes .Mortality and non-fatal serious adverse events were not increased .
AUTHORS ' CONCLUSIONS Compared to placebo , aliskiren lowered BP and this effect is dose-dependent .
This magnitude of BP lowering effect is similar to that for angiotensin-converting enzyme ( ACE ) inhibitors and angiotensin receptor blockers ( ARBs ) .
There is no difference in mortality , nonfatal serious adverse events or withdrawal due to adverse effects with short term aliskiren monotherapy .
BACKGROUND Hypertension is a chronic condition associated with an increased risk of mortality and morbidity .
Renin is the enzyme responsible for converting angiotensinogen to angiotensin I , which is then converted to angiotensin II .
Renin inhibitors are a new class of drugs that decrease blood pressure ( BP ) by preventing the formation of both angiotensin I and angiotensin II .
OBJECTIVES To quantify the dose-related BP lowering efficacy of renin inhibitors compared to placebo in the treatment of primary hypertension .
To determine the change in BP variability , pulse pressure , and heart rate and to evaluate adverse events ( mortality , non-fatal serious adverse events , total adverse events , withdrawal due to adverse effects and specific adverse events such as dry cough , diarrhoea and angioedema ) .
Direct Renin Inhibition With Aliskiren in Obese Patients With Arterial Hypertension
Current guidelines from the Joint National Committee on Prevention , Detection , Evaluation , and Treatment of High Blood Pressure recommend first-line treatment with a thiazide diuretic but do not provide specific guidance for obese patients . The renin system is activated in obesity-associated arterial hypertension . Therefore , we tested the hypothesis that the oral direct renin inhibitor aliskiren could provide additive blood pressure lowering in obese patients with hypertension ( body mass index ≥30 kg/m2 ; mean sitting diastolic blood pressure : 95 to 109 mm Hg ) who had not responded to 4 weeks of treatment with hydrochlorothiazide ( HCTZ ) 25 mg . After a 2- to 4-week washout , 560 patients received single-blind HCTZ ( 25 mg ) for 4 weeks ; 489 nonresponders were r and omly assigned to double-blind aliskiren ( 150 mg ) , irbesartan ( 150 mg ) , amlodipine ( 5 mg ) , or placebo for 4 weeks added to HCTZ ( 25 mg ) , followed by 8 weeks on double the initial doses of aliskiren , irbesartan , or amlodipine . After 8 weeks of double-blind treatment ( 4 weeks on the higher dose ) , aliskiren/HCTZ  lowered blood pressure by 15.8/11.9 mm Hg , significantly more ( P<0.0001 ) than placebo/HCTZ ( 8.6/7.9 mm Hg ) . Aliskiren/HCTZ  provided blood pressure reductions similar to those with irbesartan/HCTZ and amlodipine/HCTZ ( 15.4/11.3 and 13.6/10.3 mm Hg , respectively ) , with similar tolerability to placebo/HCTZ . Adverse event rates were highest with amlodipine/HCTZ because of a higher incidence of peripheral edema ( 11.1 % versus 0.8 % to 1.6 % in other groups ) . In conclusion , combination treatment with aliskiren is a highly effective and well-tolerated therapeutic option for obese patients with hypertension who fail to achieve blood pressure control with first-line thiazide diuretic treatment
There was a dose-dependent decrease in blood pressure for aliskiren 75 mg , 150 mg and 300 mg .
Aliskiren had no effect on blood pressure variability .
Due to very limited information available regarding change in heart rate and pulse pressure , it was not possible to meta-analyze these outcomes .Mortality and non-fatal serious adverse events were not increased .
AUTHORS ' CONCLUSIONS Compared to placebo , aliskiren lowered BP and this effect is dose-dependent .
This magnitude of BP lowering effect is similar to that for angiotensin-converting enzyme ( ACE ) inhibitors and angiotensin receptor blockers ( ARBs ) .
There is no difference in mortality , nonfatal serious adverse events or withdrawal due to adverse effects with short term aliskiren monotherapy .
BACKGROUND Hypertension is a chronic condition associated with an increased risk of mortality and morbidity .
Renin is the enzyme responsible for converting angiotensinogen to angiotensin I , which is then converted to angiotensin II .
Renin inhibitors are a new class of drugs that decrease blood pressure ( BP ) by preventing the formation of both angiotensin I and angiotensin II .
OBJECTIVES To quantify the dose-related BP lowering efficacy of renin inhibitors compared to placebo in the treatment of primary hypertension .
To determine the change in BP variability , pulse pressure , and heart rate and to evaluate adverse events ( mortality , non-fatal serious adverse events , total adverse events , withdrawal due to adverse effects and specific adverse events such as dry cough , diarrhoea and angioedema ) .