title: Addition of aliskiren to Angiotensin receptor blocker improves ambulatory blood pressure profile and cardiorenal function better than addition of benazepril in chronic kidney disease.
abstract: An altered ambulatory blood pressure (BP) and heart rate (HR) profile is related to chronic kidney disease (CKD) and cardiorenal syndrome. In this study, we examined the effects of aliskiren, when added to angiotensin II type 1 receptor blockers, on ambulatory BP and cardiorenal function in CKD. Thirty-six hypertensive CKD patients were randomly assigned to the aliskiren add-on group (n = 18) or the benazepril add-on group (n = 18). Ambulatory BP and cardiorenal function parameters were measured at baseline and 24 weeks after treatment. Compared with the benazepril group, nighttime systolic BP variability in the aliskiren group was lower after treatment. Albuminuria was decreased in the aliskiren group, but not in the benazepril group. In addition, left ventricular mass index (LVMI) was significantly lower in the aliskiren group than in the benazepril group after treatment. In the aliskiren group, multivariate linear regression analysis showed an association between changes in albuminuria and changes in nighttime systolic BP. Furthermore, there were associations between changes in LVMI and changes in daytime HR variability, as well as between changes in LVMI and changes in plasma aldosterone concentration. These results suggest that aliskiren add-on therapy may be beneficial for suppression of renal deterioration and pathological cardiac remodeling through an improvement that is effected in ambulatory BP and HR profiles.
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan. t106008a@yokohama-cu.ac.jp
authors.forename: Masato
authors.initials: M
authors.lastname: Ohsawa
authors.forename: Kouichi
authors.initials: K
authors.lastname: Tamura
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Kanaoka
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Wakui
authors.forename: Akinobu
authors.initials: A
authors.lastname: Maeda
authors.forename: Toru
authors.initials: T
authors.lastname: Dejima
authors.forename: Kengo
authors.initials: K
authors.lastname: Azushima
authors.forename: Kazushi
authors.initials: K
authors.lastname: Uneda
authors.forename: Ryu
authors.initials: R
authors.lastname: Kobayashi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Tsurumi-Ikeya
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Toya
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fujikawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000188:drug therapy; D000577:Amides / Q000627:therapeutic use*; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001552:Benzazepines / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D059347:Cardio-Renal Syndrome / Q000188:drug therapy; D005260:Female; D005650:Fumarates / Q000627:therapeutic use*; D006334:Heart Function Tests / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy; D007677:Kidney Function Tests; D008297:Male; D018384:Oxidative Stress / Q000187:drug effects; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*
chemical_list: D000577:Amides; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001552:Benzazepines; D005650:Fumarates; C446481:aliskiren; C044946:benazepril