title: Haemodynamic effects of aliskiren in decompensated severe heart failure.
abstract: OBJECTIVE
  The renin-angiotensin-aldosterone system (RAAS) has dual pathways to angiotensin II production; therefore, multiple blockages may be useful in heart failure. In this study, we evaluated the short-term haemodynamic effects of aliskiren, a direct renin inhibitor, in patients with decompensated severe heart failure who were also taking angiotensin-converting enzyme (ACE) inhibitors.
  
  
  METHODS
  A total of 16 patients (14 men, two women, mean age: 60.3 years) were enrolled in the study. The inclusion criteria included hospitalisation due to decompensated heart failure, ACE inhibitor use, and an ejection fraction < 40% (mean: 21.9 ± 6.7%). The exclusion criteria were: creatinine > 2.0 mg/dl, cardiac pacemaker, serum K(+) > 5.5 mEq/l, and systolic blood pressure < 70 mmHg. Patients either received 150 mg/d aliskiren for 7 days (aliskiren group, n = 10) or did not receive aliskiren (control group, n = 6). Primary end points were systemic vascular resistance and cardiac index values. Repeated-measures analysis of variance (ANOVA) was used to assess variables before and after intervention. A two-sided p-value < 0.05 was considered statistically significant.
  
  
  RESULTS
  Compared to pre-intervention levels, systemic vascular resistance was reduced by 20.4% in aliskiren patients, but it increased by 2.9% in control patients (p = 0.038). The cardiac index was not significantly increased by 19.0% in aliskiren patients, but decreased by 8.4% in control patients (p = 0.127). No differences in the pulmonary capillary or systolic blood pressure values were observed between the groups.
  
  
  CONCLUSIONS
  Aliskiren use reduced systemic vascular resistance in patients with decompensated heart failure taking ACE inhibitors.
authors: University of Sao Paulo, Cotoxo Hospital, Heart Institute (InCor), Sao Paulo, Brazil. eulerbrancalhao@gmail.com
authors: Euler O
authors: EO
authors: Brancalhao
authors: Marcelo E
authors: ME
authors: Ochiai
authors: Juliano N
authors: JN
authors: Cardoso
authors: Kelly R
authors: KR
authors: Vieira
authors: Raphael N
authors: RN
authors: Puig
authors: Marcelo V
authors: MV
authors: Lima
authors: Antonio P
authors: AP
authors: Barretto
mesh_terms: D000577:Amides / Q000494:pharmacology* / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D005260:Female; D005650:Fumarates / Q000494:pharmacology* / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D005650:Fumarates; C446481:aliskiren