J Clin Hypertens (Greenwich). © 2010 Wiley Periodicals, Inc.
Patients with stage 2 hypertension (systolic blood pressure [SBP] ≥160 mm Hg and/or diastolic blood pressure [DBP] ≥100 mm Hg) are at high cardiovascular risk and require intensive blood pressure (BP)–lowering therapy. This randomized double-blind study is the first prospective trial specifically designed to evaluate the direct renin inhibitor aliskiren in patients with a mean sitting SBP ≥160 mm Hg and <180 mm Hg (the lower ranges of stage 2 systolic hypertension). After a 2- to 4-week washout period, 688 patients were randomized to once-daily aliskiren/hydrochlorothiazide (HCT) 150/12.5 mg or aliskiren 150 mg for 1 week and then double the doses for 11 weeks. Baseline BP was 167.1/95.0 mm Hg. At week 12, both aliskiren/HCT and aliskiren provided substantial BP reductions from baseline (30.0/12.6 mm Hg and 20.3/8.2 mm Hg, respectively). Aliskiren/HCT lowered BP significantly more than aliskiren (least-squares mean between-treatment differences [95% confidence interval] were –9.7 [−12.0 to −7.4] for SBP and −4.5 [−5.8 to −3.2] for DBP; both P<.0001). Similar BP reductions were seen in the subgroups of patients with isolated systolic hypertension and obesity. Aliskiren, with or without HCT, provides clinically significant BP reductions and may therefore be an effective treatment option in patients with stage 2 hypertension. J Clin Hypertens (Greenwich). 2010;12:917–926. © 2010 Wiley Periodicals, Inc.