BACKGROUND: Applying a direct renin inhibitor (DRI) to advanced stage chronic kidney disease (CKD) patients is a matter of controversy. The purpose of this study was to evaluate the effect of the DRI, aliskiren, in patients with therapy-resistant hypertension undergoing hemodialysis (HD). METHODS: The study was a prospective, randomized multicenter trial exploring the antihypertensive effect of aliskiren in comparison with amlodipine, a calcium channel blocker, in patients undergoing HD. A total of 83 participants whose blood pressure (BP) had previously been treated with more than one antihypertensive agent and not having achieved the BP goal of <140/90 mmHg were randomly assigned to either aliskiren 150 mg or amlodipine 5 mg as an add-on therapy. RESULTS: A significant decrease in pre-dialysis clinic BP and home BP was found only in the amlodipine group and not in the aliskiren group. In contrast, there was a significant decrease in atrial natriuretic peptide (ANP) in the aliskiren group but not in the amlodipine group. N-terminal pro-B-type natriuretic hormone remained unchanged in both groups. Aliskiren significantly reduced angiotensin I and II, plasma renin activity, and increased plasma renin content. However, such changes were not observed in the amlodipine group. CONCLUSION:Amlodipine, not aliskiren, effectively reduces BP in CKD patients with refractory hypertension undergoing HD. Aliskiren suppresses the renin-angiotensin system and reduces ANP. Whether the DRI is beneficial in improving cardiovascular events in patients undergoing HD remains to be elucidated in future studies.
RCT Entities:
BACKGROUND: Applying a direct renin inhibitor (DRI) to advanced stage chronic kidney disease (CKD) patients is a matter of controversy. The purpose of this study was to evaluate the effect of the DRI, aliskiren, in patients with therapy-resistant hypertension undergoing hemodialysis (HD). METHODS: The study was a prospective, randomized multicenter trial exploring the antihypertensive effect of aliskiren in comparison with amlodipine, a calcium channel blocker, in patients undergoing HD. A total of 83 participants whose blood pressure (BP) had previously been treated with more than one antihypertensive agent and not having achieved the BP goal of <140/90 mmHg were randomly assigned to either aliskiren 150 mg or amlodipine 5 mg as an add-on therapy. RESULTS: A significant decrease in pre-dialysis clinic BP and home BP was found only in the amlodipine group and not in the aliskiren group. In contrast, there was a significant decrease in atrial natriuretic peptide (ANP) in the aliskiren group but not in the amlodipine group. N-terminal pro-B-type natriuretic hormone remained unchanged in both groups. Aliskiren significantly reduced angiotensin I and II, plasma renin activity, and increased plasma renin content. However, such changes were not observed in the amlodipine group. CONCLUSION:Amlodipine, not aliskiren, effectively reduces BP in CKDpatients with refractory hypertension undergoing HD. Aliskiren suppresses the renin-angiotensin system and reduces ANP. Whether the DRI is beneficial in improving cardiovascular events in patients undergoing HD remains to be elucidated in future studies.
Authors: F Persson; P Rossing; H Reinhard; T Juhl; C D A Stehouwer; C Schalkwijk; A H J Danser; F Boomsma; E Frandsen; H-H Parving Journal: Diabetologia Date: 2010-05-18 Impact factor: 10.122
Authors: Bernhard Pilz; Erdenechimeg Shagdarsuren; Maren Wellner; Anette Fiebeler; Ralf Dechend; Petra Gratze; Silke Meiners; David L Feldman; Randy L Webb; Ingrid M Garrelds; A H Jan Danser; Friedrich C Luft; Dominik N Müller Journal: Hypertension Date: 2005-08-15 Impact factor: 10.190
Authors: Stevo Julius; Sverre E Kjeldsen; Michael Weber; Hans R Brunner; Steffan Ekman; Lennart Hansson; Tsushung Hua; John Laragh; Gordon T McInnes; Lada Mitchell; Francis Plat; Anthony Schork; Beverly Smith; Alberto Zanchetti Journal: Lancet Date: 2004-06-19 Impact factor: 79.321