Aliskiren monotherapy does not cause paradoxical blood pressure rises: meta-analysis of data from 8 clinical trials

Hypertension
Alice V StantonMargaret F Prescott

Abstract

Angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and diuretics all cause reactive rises in plasma renin concentration, but particularly high levels have been reported with aliskiren. This prompted speculation that blockade of plasma renin activity with aliskiren could be overwhelmed, leading to paradoxical increases in blood pressure. This meta-analysis of data from 4877 patients from 8 randomized, double-blind, placebo- and/or active-controlled trials examined this hypothesis. The analysis focused on the incidence of paradoxical blood pressure increases above predefined thresholds, after > or =4 weeks of treatment with 300 mg of aliskiren, angiotensin receptor blockers (300 mg of irbesartan, 100 mg of losartan, or 320 mg of valsartan), 10 mg of ramipril, 25 mg of hydrochlorothiazide, or placebo. There were no significant differences in the frequency of increases in systolic (>10 mm Hg; P=0.30) or diastolic (>5 mm Hg; P=0.65) pressure among those treated with aliskiren (3.9% and 3.1%, respectively), angiotensin receptor blockers (4.0% and 3.7%), ramipril (5.7% and 2.6%), or hydrochlorothiazide (4.4% and 2.7%). Increases in blood pressure were considerably more frequent in the placebo group (12.6% and 11....Continue Reading

References

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Citations

Nov 10, 2009·Current Hypertension Reports·Rekha Pinto, Alan H Gradman
Apr 15, 2011·International Journal of Clinical Practice·D RichterC Militaru
Apr 19, 2011·World Journal of Cardiology·Gaurav Alreja, Jacob Joseph
Mar 7, 2012·Expert Review of Cardiovascular Therapy·Eric Judd, Edgar A Jaimes
Nov 26, 2010·Expert Opinion on Drug Metabolism & Toxicology·Gianpaolo ReboldiPaolo Verdecchia
Mar 19, 2011·Journal of the American Society of Hypertension : JASH·Keith C FerdinandEdgar A Jaimes
Jun 7, 2011·Biochemical Pharmacology·Diego Rodríguez-PenasFrancisca Lago
Mar 15, 2013·Therapeutic Advances in Cardiovascular Disease·Luis Juncos
Jun 10, 2017·Journal of Clinical Medicine·Nikolaos-Dimitrios PantzarisDimitrios Velissaris
Jun 23, 2010·Nature Reviews. Cardiology·Ludovit Paulis, Thomas Unger
Feb 15, 2011·American Journal of Therapeutics·Addison A Taylor, James L Pool
May 17, 2013·International Heart Journal·Yuji YoshitomiSatoru Suwa
Aug 19, 2011·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Haroon-Ur Rashid, Christian Mende

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