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 ) .
Left ventricular systolic and diastolic function, remodelling, and clinical outcomes among patients with diabetes following myocardial infarction and the influence of direct renin inhibition with aliskiren.
AIMS We assessed the relationship between diabetes and cardiac structure and function following myocardial infa rct ion ( MI ) and whether diabetes influences the effect of direct renin inhibition on change in left ventricular ( LV ) size . METHODS AND RESULTS The ASPIRE trial enrolled 820 patients 2 - 8 weeks after MI with ejection fraction ≤ 45 % and r and omized them to the direct renin inhibitor aliskiren ( n= 423 )  or placebo ( n = 397 ) added to st and ard medical therapy . Echocardiography was performed at baseline and after 36 weeks in 672 patients with evaluable paired studies . Compared with non-diabetic patients , diabetic patients ( n = 214 ) were at higher risk for a composite of cardiovascular ( CV ) death , heart failure hospitalization , recurrent MI , stroke , or aborted sudden death ( 14 vs. 7 % ; adjusted hazard ratio 1.63 , 95 % confidence interval 1.01 - 2.64 , P= 0.045 ) , despite similar left ventricular ejection fraction ( 37.9 ± 5.3 vs. 37.6 ± 5.2 % , P= 0.48 ) and end-systolic volume ( ESV ) ( 84 ± 25 vs. 82 ± 28 mL , P= 0.46 ) . Diabetic patients demonstrated greater concentric remodelling ( relative wall thickness 0.38 ± 0.07 vs. 0.36 ± 0.07 , P= 0.0002 ) and evidence of higher LV filling pressure ( E/E ' 11.1 ± 5.3 vs. 9.1 ± 4.3 , P= 0.0011 ) . At 36 weeks , diabetic patients experienced similar per cent reduction in ESV overall ( -4.9 ± 17.9 vs. -5.5 ± 16.9 , P= 0.67 ) but tended to experience greater reduction in ESV than non-diabetic patients when treated with aliskiren ( interaction P = 0.08 ) . CONCLUSIONS Compared with non-diabetic patients , diabetic patients are at increased risk of CV events post-MI despite no greater LV enlargement or reduction in systolic function . Diabetic patients demonstrate greater concentric remodelling and evidence of higher LV filling pressure , suggesting diastolic dysfunction as a potential mechanism for the higher risk observed among these patients
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 ) .