Comparative Efficacy of Aliskiren Monotherapy and Ramipril Monotherapy in Patients with Stage 2 Systolic Hypertension: Subgroup Analysis of a Double‐blind, Active Comparator Trial

Abstract

Aliskiren is the first direct renin inhibitor approved for the treatment of hypertension. Blood pressure (BP) control in stage 2 hypertension with aliskiren monotherapy has not been reported. This was a post hoc analysis of the subgroup of patients with stage 2 systolic hypertension (baseline mean sitting systolic BP [msSBP] ≥160 mmHg) who completed the 12-week monotherapy phase of a 6-month, double-blind, randomized study. A total of 175 patients were randomized to aliskiren 150 mg (n = 88) or ramipril 5 mg (n = 87) with optional up-titration to aliskiren 300 mg or ramipril 10 mg, respectively, at weeks 6 and 12. In the subgroup of patients with stage 2 systolic hypertension, aliskiren lowered msSBP and mean sitting diastolic BP (msDBP) by 22.3/12.7 mmHg from baseline to week 12; compared with a reduction of 18.1/10.2 mmHg with ramipril. The maximum BP reductions achieved with aliskiren were 60.0/34.0 mmHg (from a baseline of 172.7/107.3 mmHg). Aliskiren was noninferior (P < 0.0001) to ramipril for SBP reduction with nonsignificant superiority (P = 0.052), and superior (P = 0.043) to ramipril for DBP reduction. The proportion of patients who achieved BP control (<140/90 mmHg) after 12 weeks of monotherapy was larger with aliskiren (34/88, 38.6%) than with ramipril (22/87, 25.3%; P = 0.038). In this post hoc analysis, 12 weeks of monotherapy with aliskiren 150-300 mg provided effective mean BP reductions (22/13 mmHg) and was superior to ramipril 5-10 mg in controlling BP in patients with stage 2 systolic hypertension.

Comparative study of amlodipine versus ramipril and their effects on markers of renal disease in type 2 diabetes mellitus

“…17 At 24 weeks, SBP goals (<135 mm Hg) is achieved by 89.58% while for DBP is 87.50% (< 85 mmHg) in our study (Table 6). …”

“…16,17 Comparison between Group A and Group B On comparing Amlodipine therapy (Group A) versus Ramipril therapy (Group B), it was found that both the therapies are equally effective in improving the SBP, DBP and MAP at 12 and 24 weeks (Table 3 and Table 4). Whereas, both the therapies had not shown statistically significant difference on the blood urea, s. sodium, s. potassium, s. chloride, s. bilirubin, SGOT and SGPT levels at 12 weeks and 24 weeks, respectively.…”

Comparative Study of Rosuvastatin as Monotherapy Versus Rosuvastatin with Ramipril in Dyslipidemia and Their Effects on Atherosclerosis

“…HDL level rises at 6 weeks was less as revealed by Jayram et al while it was more than as observed by Shepherd et al [17] and Yamazaki et al [11] at 12 weeks. SBP and DBP fall by 13.72% and 19.52% that were more as revealed by MacMohan et al (5.26% and 5.06% respectively, with ramipril 5-10 mg/day) [18], Anderson K et al (5.26% and 5.06% with ramipril 5-10 mg /day) [19] and Lonn et al (4.52% and 2.618% with ramipril 10 mg/day at 4 weeks) [14] but less as observed by Soni U et al (25.40% and 16.89% with ramipril 10 mg/day at 12 weeks) [20].…”

Treatment with aliskiren/amlodipine combination in patients with moderate-to-severe hypertension: a randomised, double-blind, active comparator trial

“…Use of an aliskirenbased regimen has shown an advantage over an ARB-based regimen in its ability to reduce BP in patients with metabolic syndrome (33). Aliskiren has also demonstrated improved efficacy over ACE inhibitors, in patients with moderate-to-severe hypertension (34). Differences in drug efficacy and metabolism based on ethnic variations are widely acknowledged.…”