RT Journal Article
SR Electronic
T1 Comparable effect of aliskiren or a diuretic added on an angiotensin II receptor blocker on augmentation index in hypertension: a multicentre, prospective, randomised study
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e000591
DO 10.1136/openhrt-2017-000591
VO 4
IS 1
A1 Toru Miyoshi
A1 Takashi Murakami
A1 Satoru Sakuragi
A1 Masayuki Doi
A1 Seiji Nanba
A1 Atsushi Mima
A1 Youkou Tominaga
A1 Takafumi Oka
A1 Yutaka Kajikawa
A1 Kazufumi Nakamura
A1 Hiroshi Ito
YR 2017
UL http://openheart.bmj.com/content/4/1/e000591.abstract
AB Background The effects of antihypertensive drug combination therapy on central blood pressure (BP) and augmentation index (AI) have not been fully elucidated. We investigated the effects of the direct renin inhibitor, aliskiren, or a diuretic added to an angiotensin II receptor blocker on AI in patients with essential hypertension.Methods A 24-week, prospective, multicentre, randomised, open-label study enrolled 103 patients already treated with valsartan. Participants were randomly allocated to receive either valsartan with aliskiren (V+A), or valsartan with trichlormethiazide (V+T). The primary outcome was the change in AI derived from radial artery tonometry. Secondary outcome measures included systolic and diastolic BP, cardio-ankle vascular index (CAVI, which reflects arterial stiffness) and urinary 8-hydroxydeoxyguanosine concentration.Results After 24 weeks, systolic and diastolic BP were significantly reduced in both groups to a broadly comparable extent. There was no significant difference in AI at the end of the study between the V+A group and the V+T group (between-group difference: −2.3%, 95% CI −6.9% to 2.2%, p=0.31). Central BP at the end of the study also did not differ between the two groups (p=0.62). There was no significant difference in the CAVI between the groups at the end of the study. Urinary 8-hydroxydeoxyguanosine concentration was significantly lower in the V+A group than in the V+T group (p<0.01), suggesting that V+A attenuated oxidative stress more than V+T.Conclusion The combination of valsartan and aliskiren had an effect on AI comparable with that of the combination of valsartan and trichlormethiazide.UMIN Clinical Trial Registration number UMIN000005726.