title: Differential effects of aliskiren/amlodipine combination and high-dose amlodipine monotherapy on endothelial function in elderly hypertensive patients.
abstract: BACKGROUND
  The aim of this study was to compare the effects of direct renin inhibitor, aliskiren, and amlodipine combination therapy with those of high-dose amlodipine monotherapy on endothelial function in elderly hypertensive patients.
  
  
  METHODS
  Participants included 105 patients (mean age 77 years) who had receive 5mg amlodipine for 4 weeks. Patients were allocated to the aliskiren/amlodipine group (AL/AM) or the high-dose amlodipine (AM) group. The AL/AM group received 150mg aliskiren in addition to 5mg amlodipine for 8 weeks; then the dose of aliskiren was doubled to 300mg for another 8 weeks. The AM group received 10mg amlodipine for 16 weeks. Of the 105 patients, 87 who underwent measurements of brachial flow-mediated vasodilation (FMD) and nitroglycerin-mediated vasodilation (NMD) before and after the study were included in the analysis.
  
  
  RESULTS
  Blood pressure-lowering effects were similar in the 2 groups. Plasma renin activity significantly decreased in the AL/AM group (P < 0.001) but increased in the AM group (P < 0.001). Improvement of FMD was found in the AL/AM group (2.6% to 3.7%, P = 0.001) but not in the AM group, while NMD did not change in either group. The changes in 24-hour systolic blood pressure (r = -0.60, P < 0.001) and diastolic blood pressure (r = -0.46, P = 0.004) were significantly correlated with improvement of FMD in the AL/AM group but not in the AM group.
  
  
  CONCLUSIONS
  Addition of aliskiren improved endothelial function in elderly hypertensive patients treated with amlodipine.
  
  
  BACKGROUND
  UMIN000010163.
authors.affiliation: Yanai Municipal Heigun Clinic, Yamaguchi, Japan.
authors.forename: Motoki
authors.initials: M
authors.lastname: Fukutomi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hoshide
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mizuno
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage*; D017311:Amlodipine / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D005650:Fumarates / Q000008:administration & dosage*; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007564:Japan; D008297:Male; D012083:Renin / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome; D014664:Vasodilation / Q000187:drug effects*; D014665:Vasodilator Agents / Q000008:administration & dosage*; D000092502:Renin Inhibitors
chemical_list: D000577:Amides; D017311:Amlodipine; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D005650:Fumarates; D012083:Renin; D014665:Vasodilator Agents; D000092502:Renin Inhibitors; C446481:aliskiren
keywords: ambulatory blood pressure; blood pressure; calcium channel blocker; direct renin inhibitor; endothelial function; hypertension.