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 ) .
Efficacy and safety of the direct renin inhibitor aliskiren and ramipril alone or in combination in patients with diabetes and hypertension
Objective . To assess the antihypertensive efficacy and safety of the combination of the direct renin inhibitor aliskiren and ramipril in patients with diabetes and hypertension . Methods . In this double-blind , multicentre trial , 837 patients with diabetes mellitus and hypertension ( mean sitting diastolic blood pressure [ BP ] > 95 and < 110 mmHg ) were r and omised to once-daily aliskiren ( 150 mg titrated to 300 mg after four weeks ; n=282 ) , ramipril ( 5 mg titrated to 10 mg ; n=278 ) or the combination ( n=277 ) for eight weeks . Efficacy variables were cuff mean sitting diastolic BP ( msDBP ) and mean sitting systolic BP ( msSBP ) ; 24-hour ambulatory BP , plasma renin activity ( PRA ) and plasma renin concentration ( PRC ) were also assessed . Results . At week 8 , aliskiren , ramipril and aliskiren/ramipril  lowered msDBP ( mean±SEM ) by 11.3±0.5 , 10.7±0.5 and 12.8±0.5 mmHg , and msSBP by 14.7±0.9 , 12.0±0.9 and 16.6±0.9 mmHg , respectively . Aliskiren/ramipril provided superior msDBP reductions to ramipril ( p=0.004 ) or aliskiren ( p=0043 ) monotherapy ; adding aliskiren to ramipril provided an additional mean BP reduction of 4.6/2.1 mmHg . Aliskiren monotherapy was non-inferior to ramipril for msDBP reduction ( p=0.0002 ) and superior for msSBP reduction (p=0.021).All treatments significantly lowered mean 24-hour ambulatory BP . Aliskiren significantly reduced PRA from baseline as monotherapy ( by 66 % , p<0.0001 ) or in combination with ramipril ( by 48 % , p<0.0001 ) , despite large increases in PRC in all treatment groups . Aliskiren was well tolerated as monotherapy or in combination with ramipril . Conclusions . Combining aliskiren with ramipril provided a greater reduction in msDBP than either drug alone in patients with diabetes and hypertension
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 ) .