Journal Article10.1097/HJH.0B013E328351C263
Sustained decrease in blood pressure following missed doses of aliskiren or telmisartan: the ASSERTIVE double-blind, randomized study.
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TL;DR: Aliskiren showed a greater and more sustained BP-lowering effect than telmisartan during a 7-day treatment withdrawal in patients with hypertension, and may provide sustained BP lowering during 1 day or more missed dose.
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Abstract: Objectives: The AliSkiren Study of profoundantihypERtensive efficacy in hyperTensIVE patients(ASSERTIVE) study was designed to assess the sustainedblood pressure (BP)-lowering effect of aliskiren vs.telmisartan after a 7-day treatment withdrawal in patientswith hypertension.Methods: Patients were randomized to once-daily aliskiren150mg (N¼414) or telmisartan 40mg (N¼408). After2 weeks, all patients were uptitrated to double the initialdose for 10 weeks; subsequently, all patients were treatedwith placebo to simulate a 7-day treatment withdrawal.Results: At the end of active treatment (EoA), similardecreases in mean ambulatory BP were observed withaliskiren and telmisartan. From EoA to day 7 of treatmentwithdrawal (end of withdrawal, EoW), the least squaresmean increase in 24-h mean ambulatory SBP was smallerfor aliskiren (2.7mmHg) vs. telmisartan (6.5mmHg).Between-treatment difference was significant in favour ofaliskiren ( 3.8mmHg; P<0.0001). Similar effects wereobserved for the increase in 24-h mean ambulatory DBPafter EoW ( 2.1mmHg; P<0.0001). Mean sitting SBP andDBP were also significantly lower with aliskiren thantelmisartan after EoW with SBP (2.0mmHg) and DBP(1.1mmHg) differences in favour of aliskiren, alreadyevident on day 2 after a single ‘missed dose’.Conclusion: Aliskiren showed a greater and moresustained BP-lowering effect than telmisartan during a7-day treatment withdrawal. Aliskiren may providesustained BP lowering during 1 day or more missed dose.Keywords: aliskiren, ambulatory blood pressure,angiotensin receptor blocker, antihypertensive therapy,blood pressure variability, direct renin inhibitor, drugholiday, telmisartanAbbreviations: ABPM, ambulatory blood pressuremonitoring; ARB, angiotensin receptor blocker; CI,confidence interval; EoA, end of active treatment; EoW,end of withdrawal; Geo-mean, geometric mean; LSM,least squares mean; MABP, mean ambulatory BP; MADBP,mean ambulatory DBP; MASBP, mean ambulatory SBP;msSBP, mean sitting SBP; msDBP, mean sitting DBP; PRA,plasma renin activity; PRC, plasma renin concentration;RAAS, renin–angiotensin–aldosterone system; RAN,randomization; SAE, serious adverse event
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Citations
Renin-Angiotensin System and Sympathetic Neurotransmitter Release in the Central Nervous System of Hypertension
TL;DR: Evidence is discussed in support of the concept that the brain renin-angiotensin system (RAS) might be linked to sympathetic nerve activity in hypertension and the possible relationship between the brain RAS and sympathetic neurotransmitter release in the central nervous system of hypertension.
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AT1 antagonism and renin inhibition in mice: pivotal role of targeting angiotensin II in chronic kidney disease.
Christoph Fraune,Sascha Lange,Christian Krebs,Alexandra Hölzel,Jana Baucke,Nevena Divac,Edzard Schwedhelm,Thomas Streichert,Joachim Velden,Ingrid M. Garrelds,A.H. Jan Danser,Anne-Roos Frenay,Harry van Goor,Vera Jankowski,Rolf A.K. Stahl,Genevieve Nguyen,Ulrich Wenzel +16 more
TL;DR: Equieffective nephroprotection of renin inhibition and AT(1) antagonism in mice with chronic kidney disease without additional benefit of combination therapy is demonstrated.
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Renin Inhibition with Aliskiren: A Decade of Clinical Experience
Nikolaos-Dimitrios Pantzaris,Evangelos Karanikolas,Konstantinos Tsiotsios,Dimitrios Velissaris +3 more
TL;DR: The purpose of this review is to present the currently available data regarding established and future potential clinical uses of aliskiren.
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Antihypertensive efficacy of angiotensin receptor blockers as monotherapy as evaluated by ambulatory blood pressure monitoring: a meta-analysis
Harikrishna Makani,Sripal Bangalore,Azhar Supariwala,Jorge Romero,Edgar Argulian,Franz H. Messerli +5 more
TL;DR: A shallow dose-response curve was observed, and uptitration marginally enhanced the antihypertensive efficacy of ARBs by 24 h ABP, and blood pressure reduction with losartan at starting dose and at max dose was consistently inferior to the other ARBs.
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