Aliskiren HCTZ Compared to Amlodipine in Patients With Stage 2 Systolic Hypertension and Diabetes Mellitus
Condition: Hypertension; Diabetes Mellitus
MeSH terms: Hypertension; Isolated Systolic Hypertension; Diabetes Mellitus; Systolic Murmurs
Intervention: Amlodipine; Hydrochlorothiazide (HCTZ); Aliskiren
Intervention description: Amlodipine 5 mg for 1 week followed by Amlodipine 10 mg for 7 weeks; Hydrochlorothiazide 12.5 mg for 1 week followed by Hydrochlorothiazide 25 mg for 7 weeks; Aliskiren 150 mg for 1 week followed by Aliskiren 300 mg for 7 weeks
Intervention MeSH terms: Amlodipine; Hydrochlorothiazide
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Enrollment: 860.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Hypertension, diabetes mellitus, aliskiren, hydrochlorothiazide, systolic blood pressure, diastolic blood pressure, amlodipine, stage 2

Summary:

      The purpose of the study is to evaluate the blood pressure lowering effect and safety of
      aliskiren in combination with Hydrochlorothiazide (HCTZ) given to diabetic patients with
      stage 2 systolic hypertension (mean sitting systolic blood pressure (msSBP) ≥ 160 mm Hg and <
      200 mm Hg).
    

Eligibility criteria:

        Inclusion criteria:

          1. Male or female outpatients ≥ 18 years old.

          2. Patients with a diagnosis of stage 2 hypertension (defined as an office cuff msSBP ≥
             160 mmHg and < 200 mmHg) at Visit 5 (randomization).

          3. Patients with diabetes mellitus (Type 2) with an HbA1c at visit 1 ≤ 9.0 % and
             currently on stable anti-diabetic regimen or stable diet and exercise for at least 4
             weeks prior to visit 1.

          4. Patients who are eligible and able to participate in the study, and who are willing to
             give written informed consent before any assessment is performed.

        Exclusion criteria:

          1. Office blood pressure measured by cuff (msSBP ≥ 200 mmHg or msDBP ≥ 110 mmHg) at
             Visits 1-5.

          2. History or evidence of secondary hypertension of any etiology (e.g., uncorrected renal
             artery stenosis, pheochromocytoma).

          3. History of hypertensive encephalopathy or heart failure (NYHA Class II-IV).

          4. Cerebrovascular accident, transient ischemic cerebral attack (TIA), coronary bypass
             surgery, myocardial infarction or any percutaneous coronary intervention (PCI) within
             1 year prior to Visit 1.

          5. Serum sodium less than the lower limit of normal, serum potassium < 3.5 mEq/L
             (corresponding to 3.5 mmol/L) or ≥ 5.3 mEq/L (corresponding to 5.3 mmol/L), or
             dehydration at Visit 1.

          6. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a
             female after conception and until the termination of gestation, confirmed by a
             positive hCG laboratory test (> 5 mIU/mL).

          7. Use of other investigational drugs within 30 days of enrollment.

          8. History of hypersensitivity to any of the study drugs or to drugs belonging to the
             same therapeutic class (thiazide diuretics, renin inhibitors, calcium channel
             blockers, or dihydropyridine like calcium channel blockers) as the study drugs.

          9. History of gouty arthritis.

         10. Long QT syndrome or QTc > 450 msec for males and > 470 msec for females at screening.

         11. History of malignancy of any organ system (other than localized basal cell carcinoma
             of the skin), treated or untreated, within the past 5 years, regardless of whether
             there is evidence of local recurrence or metastases.

         12. Women of child-bearing potential, defined as all women physiologically capable of
             becoming pregnant including women whose career, lifestyle, or sexual orientation
             precludes intercourse with a male partner and women whose partners have been
             sterilized by vasectomy or other means, UNLESS they are using two birth control
             methods. The two methods can be a double barrier method or a barrier method plus a
             hormonal method.

               -  Adequate barrier methods of contraception include: diaphragm, condom (by the
                  partner), intrauterine device (copper or hormonal), sponge or spermicide.
                  Hormonal contraceptives include any marketed contraceptive agent that includes an
                  estrogen and/or a progestational agent. Reliable contraception should be
                  maintained throughout the study and for 7 days after study drug discontinuation.

               -  Women are considered post-menopausal and not of child bearing potential if they
                  have had 12 months of natural (spontaneous) amenorrhea with an appropriate
                  clinical profile (e.g. age appropriate, history of vasomotor symptoms) or six
                  months of spontaneous amenorrhea with serum FSH levels > 40 mIU/mL (and
                  estradiol< 20 pg/mL) or have had surgical bilateral oophorectomy (with or without
                  hysterectomy) at least six weeks ago. In the case of oophorectomy alone, only
                  when the reproductive status of the woman has been confirmed by follow up hormone
                  level assessment.

         13. Known Keith-Wagener grade III or IV hypertensive retinopathy.

         14. Current angina pectoris requiring pharmacological therapy (except sublingual
             nitroglycerin).

         15. Second or third degree heart block without a pacemaker.

         16. Atrial fibrillation or atrial flutter at Visit 1, or potentially life-threatening or
             any symptomatic arrhythmia during the 12 months prior to Visit 1.

         17. Clinically significant valvular heart disease.

         18. History of angioedema during use of an ACE inhibitor.

         19. History or evidence of drug or alcohol abuse within the last 12 months.

         20. Any surgical or medical condition, which in the opinion of the investigator, may place
             the patient at higher risk from his/her participation in the study, or is likely to
             prevent the patient from complying with the requirements of the study or completing
             the study.

         21. Any surgical or medical condition which might significantly alter the absorption,
             distribution, metabolism, or excretion of study drugs including, but not limited to,
             any of the following:

               -  History of major gastrointestinal tract surgery such as gastrectomy,
                  gastroenterostomy, or bowel resection.

               -  History of active inflammatory bowel disease during the 12 months prior to Visit
                  1.

               -  Currently active gastritis, duodenal or gastric ulcers, or gastrointestinal
                  bleeding during the 3 months prior to Visit 1.

               -  Any history of pancreatic injury, pancreatitis, or evidence of impaired
                  pancreatic function/injury as indicated by abnormal lipase or amylase during the
                  12 months prior to Visit 1.

               -  Evidence of hepatic disease as determined by any one of the following: ALT or AST
                  values exceeding 3 x ULN at Visit 1, a history of hepatic encephalopathy, a
                  history of esophageal varices, or a history of portocaval shunt.

               -  Evidence of renal impairment as determined by any one of the following: serum
                  creatinine > 1.5 x ULN at Visit 1, a history of dialysis, or a history of
                  nephrotic syndrome.

               -  Current treatment with cholestyramine or colestipol resins

         22. History of noncompliance to medical regimes or unwillingness to comply with the study
             protocol.

         23. Any condition that in the opinion of the investigator would confound the evaluation
             and interpretation of efficacy and/or safety data.

         24. Persons directly involved in the execution of this protocol.

         25. Known contraindications to the study drugs.