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
Jan 19, 2002·Hypertension·Juerg NussbergerHans R Brunner
Aug 10, 2002·Current Hypertension Reports·Norman K Hollenberg
Nov 5, 2003·Hypertension·Alice StantonEoin O'Brien
Feb 23, 2005·Circulation·Alan H GradmanMartin P Bedigian
Mar 2, 2006·Journal of Hypertension·Michel AziziNorman K Hollenberg
Mar 21, 2007·Journal of the American College of Cardiology·Byung-Hee OhDeborah L Keefe
May 9, 2007·American Journal of Hypertension·Jean E Sealey, John H Laragh
Jun 26, 2007·International Journal of Clinical Practice·J NussbergerM F Prescott
Jul 31, 2007·Lancet·Suzanne OparilAndrew Satlin
Aug 9, 2007·Drugs·James E Frampton, Monique P Curran
Sep 1, 2007·Journal of Hypertension·Joël Ménard, Michel Azizi
Feb 21, 2008·Hypertension·A H Jan DanserNorman Hollenberg
Feb 28, 2008·Journal of Hypertension·Karl AndersenDeborah L Keefe
Apr 5, 2008·Arteriosclerosis, Thrombosis, and Vascular Biology·Wendy W BatenburgA H Jan Danser
Apr 9, 2008·Hypertension·Jürg NussbergerLucia Mazzolai
Jul 9, 2008·Hypertension·Jean E Sealey, John H Laragh
Sep 20, 2008·American Journal of Hypertension·Jean E Sealey, John H Laragh
Jan 14, 2009·Circulation·Roland E SchmiederHein van Ingen
May 22, 2009·Journal of Human Hypertension·P PalatiniD L Keefe
Jan 30, 2010·Clinical Therapeutics·Juan G PuigDeborah L Keefe
Citations
Nov 10, 2009·Current Hypertension Reports·Rekha Pinto, Alan H Gradman
Jan 30, 2010·Cardiovascular Research·Florian AlonsoJacques-Antoine Haefliger
Apr 15, 2011·International Journal of Clinical Practice·D RichterC Militaru
Jan 1, 2010·Integrated Blood Pressure Control·Konstantinos SavvatisCarsten Tschöpe
Apr 19, 2011·World Journal of Cardiology·Gaurav Alreja, Jacob Joseph
Oct 5, 2010·Drugs·Sean T DugganMonique P Curran
Feb 2, 2012·Expert Review of Cardiovascular Therapy·Abdul Ali Abdellatif
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
May 14, 2010·Postgraduate Medicine·Michael C Ruddy
Apr 19, 2020·BMC Cardiovascular Disorders·Qiyuan ZhaoYuanyuan Wang