Aliskiren in patients failing to achieve blood pressure targets with angiotensin converting enzyme inhibitors or angiotensin receptor blockers

Purpose: To assess the efficacy of aliskiren in patients failing to reach blood pressure (BP) goals with either an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB).

Methods: The study included 107 patients with hypertension that failed to reach BP goals on adequate doses and durations of therapy with an ACEI or an ARB. Patients were switched to aliskiren for a minimum of 4 weeks on its initial dose and a minimum of 4 weeks on its maximal dose (if needed). Other antihypertensive therapy was allowed as long as that therapy was not altered. Changes in BP were determined with initial ACEI and ARB therapy and after maximal aliskiren therapy. The proportion of patients who successfully achieved BP goals with aliskiren therapy was also determined. 

Results: ACEI were used in 79 patients and ARBs in 28 patients. Of these patients, only 6 received monotherapy (all on ACEI). The mean reduction in sBP and dBP with ACEI was 8.5 ± 6.3 mmHg and 6.0 ± 4.7 mmHg, respectively. The mean reduction in sBP and dBP with ARB was 8.3 ± 6.7 mmHg and 5.0 ± 5.2 mmHg, respectively. The mean reduction in sBP and dBP with aliskiren 150 mg/d was 6.7 ± 5.4 mmHg and 5.4 ± 4.8 mmHg, respectively. The mean reduction in sBP and dBP with aliskiren 300 mg/d was 8.6 ± 6.3 mmHg and 6.0 ± 4.9 mmHg, respectively. Only 1 patient achieved their BP target on aliskiren (< 1%).

Conclusion: Aliskiren is not effective in patients failing either ACEI or ARBs therapy. Given the recent restricted use of aliskiren in combination with ACEI and ARBS, its excess cost,  and the lack of outcome data, there does not appear to be a role for the use of aliskiren in clinical practice.