Sustained Blood Pressure–Lowering Effect of Aliskiren Compared With Telmisartan After a Single Missed Dose

Abstract

Poor adherence to antihypertensive drug treatment is common and is often associated with marked prolongations of the dosing interval. Hence, selecting a treatment that has the potential to provide a sustained blood pressure (BP)-lowering effect is important. The objective of this analysis is to compare the sustained efficacy of aliskiren with telmisartan after a single missed dose. This is part of a 12-week double-blind study conducted in patients with mild to moderate hypertension randomized to once-daily aliskiren 150 mg or telmisartan 40 mg for 2 weeks, force-titrated to double the doses for 10 weeks, followed by placebo for 1 week. The changes in BP from the end of active treatment (EOA) to 48 hours after treatment withdrawal (day 2) were analyzed. Demographic and baseline characteristics were comparable between the treatment groups. Aliskiren continued to show significantly greater reductions in mean sitting systolic BP ()0.7 vs +1.3 mm Hg; P<.05), 24-hour mean ambulatory systolic BP ()3.6 vs +2.6 mm Hg; P<.01), and 24-hour mean ambulatory diastolic BP ()3.7 vs +0.4 mm Hg; P<.01) compared with telmisartan from EOA to day 2, despite the similar BP reductions from randomization to EOA. In conclusion, aliskiren sustained the BP-lowering efficacy better than telmisartan after a single missed dose. J Clin Hypertens (Greenwich). 2013; 15:41-47. Ó2012 Wiley Periodicals, Inc.

Effect of aliskiren, telmisartan and torsemide on cardiac dysfunction in l-nitro arginine methyl ester (l-NAME) induced hypertension in rats

“…Aliskiren had a more sustained effect on BP compared with telmisartan [38] . The efficacy of aliskiren and its long duration of action, are largely attributed to its high potency for inhibition of human renin and its long half-life and tissue affinity.…”

Effects of exercise on central aortic pressure before and after treatment with renin–angiotensin system blockade in patients with hypertension

“…This finding is consistent with data from the ASSERTIVE study, which compared the effect of aliskiren and telmisartan on BP after a one-week treatment withdrawal. 29,30 The present study has a number of limitations, which should be addressed. This was a small study with an exploratory objective to investigate the influence of RAS-blocking treatment on the exercise-induced rise in central pressure.…”

What should patients do if they miss a dose? A systematic review of patient information leaflets and summaries of product characteristics

“…In the case of oral contraceptives, this was done to define the interval between a last-taken pill before the ovulationinducing surge of pituitary gonadotrophins appeared [21]. Similar studies have been performed with antihypertensive drugs [22][23][24][25][26][27][28][29][30] which indicate, for instance, amlodipine to be more forgiving than either enalapril or diltiazem, and to be more forgiving when combined with olmesartan than with perindopril [31]. For warfarin, pharmacokineticpharmacodynamic models have been proposed to inform labelling recommendations [32], and population pharmacokinetic models have been used to simulate missed doses of [33].…”