Blood Pressure Lowering Efficacy of Renin Inhibitor Aliskiren for Primary Hypertension

Summary

A Cochrane review [Abstract] 1 included 12 studies with a total of 7 439 mostly Caucasian subjects with mild-to-moderate uncomplicated hypertension (mean age 54 years). Aliskiren (the only renin inhibitor studied) had a dose-related systolic/diastolic blood pressure (SBP/DBP) lowering effect as compared with placebo: aliskiren 75 mg (MD -2.97, 95% CI -4.76 to -1.18)/(MD -2.05, 95% CI -3.13 to -0.96) mmHg, aliskiren 150 mg (MD -5.95, 95% CI -6.85 to -5.06)/(MD -3.16, 95% CI -3.74 to -2.58) mmHg, aliskiren 300 mg (MD -7.88, 95% CI -8.94 to -6.82)/(MD -4.49, 95% CI -5.17 to -3.82) mmHg, aliskiren 600 mg (MD -11.35, 95% CI -14.43 to -8.27)/(MD -5.86, 95% CI -7.73 to -3.99) mmHg. There was a dose-dependent decrease in blood pressure for aliskiren 75 mg, 150 mg and 300 mg. The blood pressure lowering effect of aliskiren 600 mg was not different from 300 mg. Aliskiren had no effect on blood pressure variability. Mortality and non-fatal serious adverse events were not increased. In studies of 8 week duration aliskiren did not increase withdrawal due to adverse events. The most frequent adverse events reported were headache, nasopharyngitis, diarrhoea, dizziness and fatigue. Diarrhoea was increased in a dose-dependent manner (RR 7.00, 95% CI 2.48 to 19.72) with aliskiren 600 mg.