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 ) .
A comparison of the tolerability of the direct renin inhibitor aliskiren and lisinopril in patients with severe hypertension
Patients with severe hypertension ( > 180/110 mm Hg ) require large blood pressure ( BP ) reductions to reach recommended treatment goals ( < 140/90 mm Hg ) and usually require combination therapy to do so . This 8-week , multicenter , r and omized , double-blind , parallel-group study compared the tolerability and antihypertensive efficacy of the novel direct renin inhibitor aliskiren with the angiotensin converting enzyme inhibitor lisinopril in patients with severe hypertension ( mean sitting diastolic blood pressure (msDBP)⩾105 mm Hg and < 120 mm Hg ) . In all , 183 patients were r and omized ( 2:1 ) to aliskiren 150 mg ( n=125 ) or lisinopril 20 mg ( n=58 ) with dose titration ( to aliskiren 300 mg or lisinopril 40 mg ) and subsequent addition of hydrochlorothiazide ( HCTZ ) if additional BP control was required . Aliskiren-based treatment ( ALI ) was similar to lisinopril-based treatment ( LIS ) with respect to the proportion of patients reporting an adverse event ( AE ; ALI 32.8 % ; LIS 29.3 % ) or discontinuing treatment due to AEs ( ALI 3.2 % ; LIS 3.4 % ) . The most frequently reported AEs in both groups were headache , nasopharyngitis and dizziness . At end point , ALI showed similar mean reductions from baseline to LIS in msDBP ( ALI −18.5 mm Hg vs LIS −20.1 mm Hg ; mean treatment difference 1.7 mm Hg ( 95 % confidence interval ( CI ) −1.0 , 4.4 ) ) and mean sitting systolic blood pressure ( ALI −20.0 mm Hg vs LIS −22.3 mm Hg ; mean treatment difference 2.8 mm Hg ( 95 % CI −1.7 , 7.4 ) ) . Responder rates ( msDBP<90 mm Hg and /or reduction from baseline⩾10 mm Hg ) were 81.5 % with ALI and 87.9 % with LIS . Approximately half of patients required the addition of  HCTZ  to achieve BP control ( ALI 53.6 % ; LIS 44.8 % ) . In conclusion , ALI alone , or in combination with HCTZ , exhibits similar tolerability and antihypertensive efficacy to LIS alone , or in combination with HCTZ , in patients with severe 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 ) .