title: Combination therapy with aliskiren versus ramipril or losartan added to conventional therapy in patients with type 2 diabetes mellitus, uncontrolled hypertension and microalbuminuria.
abstract: OBJECTIVE
  The aim of this study was to assess the antihypertensive efficacy and safety of aliskiren versus ramipril or losartan in hypertensive patients with type 2 diabetes mellitus, microalbuminuria and uncontrolled hypertension, despite the use of optimal conventional antihypertensive therapy.
  
  
  METHODS
  In this open-label active comparator study, 126 patients were randomly assigned to receive 24 weeks of additional therapy with aliskiren (Group A) or either losartan or ramipril (Group B), according to whether a patient was already treated with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker, respectively.
  
  
  RESULTS
  After 24 weeks, both treatment groups experienced a significant reduction of systolic blood pressure (-11.37% and -8.47%, respectively; both p <0.001 vs. baseline) and diastolic blood pressure levels (-10.67% and -9.28%, respectively; both p <0.001 vs. baseline), with a greater reduction of mean systolic values in Group A compared with Group B (p <0.001). Furthermore, after six months microalbuminuria was significantly decreased in both treatment groups (-67.62% and -49.1%, respectively; both p <0.001), with a reduction rate in Group A significantly higher than in Group B (p<0.001).
  
  
  CONCLUSIONS
  The addition of aliskiren to optimal conventional therapy provided a higher reduction of blood pressure and urinary albumin excretion when compared with the addition of losartan or ramipril.
authors: Department of Internal Medicine and Medical Therapy, University of Messina, Italy eimbalzano@unime.it.
authors: Egidio
authors: E
authors: Imbalzano
authors: Department of Internal Medicine and Medical Therapy, University of Messina, Italy.
authors: Mirko
authors: M
authors: Scarpelli
authors: Department of Internal Medicine and Medical Therapy, University of Messina, Italy.
authors: Giuseppe
authors: G
authors: Mandraffino
authors: Department of Internal Medicine and Medical Therapy, University of Messina, Italy.
authors: Michele
authors: M
authors: Creazzo
authors: Department of Internal Medicine and Medical Therapy, University of Messina, Italy.
authors: Giuseppina
authors: G
authors: Lizio
authors: Department of Internal Medicine and Medical Therapy, University of Messina, Italy.
authors: Giovanni
authors: G
authors: Trapani
authors: Department of Cardiology, University of Messina, Italy.
authors: Giuseppe
authors: G
authors: Dattilo
authors: Department of Internal Medicine, University of Verona, Italy.
authors: Andrea
authors: A
authors: Dalbeni
authors: Department of Internal Medicine and Medical Therapy, University of Messina, Italy.
authors: Carmelo
authors: C
authors: Tomasello
authors: Department of Internal Medicine and Medical Therapy, University of Messina, Italy.
authors: Maria Adriana
authors: MA
authors: Sardo
authors: Department of Internal Medicine and Medical Therapy, University of Messina, Italy.
authors: Antonino
authors: A
authors: Saitta
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D000577:Amides / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D003971:Diastole / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D005650:Fumarates / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D011188:Potassium / Q000097:blood; D017257:Ramipril / Q000627:therapeutic use*; D013599:Systole / Q000187:drug effects
chemical_list: D000577:Amides; D005650:Fumarates; C446481:aliskiren; D003404:Creatinine; D019808:Losartan; D017257:Ramipril; D011188:Potassium
keywords: Direct renin inhibitors; angiotensin receptor blockers; angiotensin-converting enzyme inhibitors; hypertension; renin–angiotensin–aldosterone system