title: Effectiveness of the direct renin inhibitor, aliskiren, in patients with resistant hypertension.
abstract: Currently there is no consensus regarding which add-on therapy to use in resistant hypertension. We have conducted an open observational study of the use of aliskiren in resistant hypertensive patients. Forty-three patients with resistant hypertension were included in the study. The inclusion criteria were as follows: 1) office blood pressure (BP) > 140/90 mmHg despite treatment with at least three or more antihypertensive drugs; 2) no prior therapy with aliskiren; and 3) no renal insufficiency. Follow-up BP was determined at 1 and 3 months. Baseline BP was 153 ± 12/79 ± 12 mmHg. After 3 months, systolic BP (SBP) and diastolic BP (DBP) dropped significantly: 140 ± 19/73 ± 13 mmHg (P < 0.0001). Twenty-one patients (49%) had an office BP < 140/90 mmHg, and these patients were assigned to the good BP control group. Another 22 were placed into the poor BP control group. BP reductions from baseline in the good BP control group (SBP/ DBP: 19 ± 11/8 ± 7 mmHg) were larger than those in the poor BP control group (5 ± 15/3 ± 9 mmHg, P < 0.05). Mean BP (MBP) values at baseline, 1, and 3 months were higher in the poor BP control group. There was no significant difference in pulse pressure at baseline between the 2 groups. In multivariate analysis, only MBP at baseline correlated with lack of BP control. Aliskiren administration to resistant hypertensive patients was effective in reducing BP. The present findings suggest aliskiren may be useful as a fourth-line or fifth-line treatment added to other drugs in the treatment of resistant hypertension.
authors.affiliation: Miyauchi Makoto Memorial Clinic.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yoshitomi
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Kawanishi
authors.forename: Akihisa
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Shun-ichiro
authors.initials: S
authors.lastname: Sakurai
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minai
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Ishii
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tarutani
authors.forename: Takashi
authors.initials: T
authors.lastname: Tsujibayashi
authors.forename: Masashi
authors.initials: M
authors.lastname: Kaneki
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Saitou
authors.forename: Satoru
authors.initials: S
authors.lastname: Suwa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000494:pharmacology / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005650:Fumarates / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy; D016896:Treatment Outcome; D000092502:Renin Inhibitors
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D005650:Fumarates; D000092502:Renin Inhibitors; C446481:aliskiren