title: The impact of age on the benefits and risks of aliskiren treatment: analyses of the 3A registry.
abstract: We aimed to analyze benefits and risks of aliskiren treatment in older adults (⩾ 65 years) in clinical practice. Patients (n = 14,986) were assigned to either aliskiren (ALIS), an angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB), or an agent not blocking the renin-angiotensin system (non-RAS). Older adults (n = 7396) had a longer history of hypertension (8.7 vs 4.7 years; P < 0.0001), lower mean diastolic blood pressure (DBP; 87.7 ± 11.0 vs 92.1 ± 11.0 mm Hg) and more renal (12.0 vs 5.6%; P < 0.0001) or cardiovascular disease (44.0 vs 18.9%; P < 0.0001); 4548 received aliskiren (68.8%), 1215 ACEi/ARBs (18.4%) and 850 non-RAS treatments (12.9%). Office BP at 1 year was reduced by 18.4 ± 21.5/7.2 ± 12.0 mm Hg. BP reductions were greater (19.5 ± 21.7/7.6 ± 12.1 mm Hg) in the aliskiren group than in the ACEi/ARB (15.6 ± 20.9/6.4 ± 11.9) and non-RAS groups (16.1 ± 20.7/6.5 ± 11.7 mm Hg), respectively (P<0.0001 for systolic BP (SBP) and <0.01 for DBP). After multivariable adjustment, differences in SBP reductions were clinically irrelevant and no differences were noted for DBP. Adverse effects were higher in older adults with no differences between treatment groups. In conclusion, the present analysis of a large, unselected cohort of patients in clinical practice from the 3A study, offers real-life evidence of the effectiveness and safety of aliskiren for the treatment of hypertension in older adults.
authors.affiliation: Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Friedrich
authors.affiliation: 1] Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany [2] Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Zeymer
authors.affiliation: Experimental and Clinical Research Center, Charité Campus Buch, HELIOS-Klinikum Berlin, Berlin, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Dechend
authors.affiliation: Clinical and Regulatory Affairs, Novartis Pharma GmbH, Nürnberg, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Hagedorn
authors.affiliation: Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Riemer
authors.affiliation: Institut für Pharmakologie und präventive Medizin, Mahlow, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Zemmrich
authors.affiliation: Institut für Pharmakologie und präventive Medizin, Mahlow, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Bramlage
authors.affiliation: Institute for Clinical Pharmacology, Medical Faculty, Technical University Dresden, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Pittrow
authors.affiliation: Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Senges
authors.affiliation: Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany.
authors.forename: R E
authors.identifier: 0000000323565883
authors.initials: RE
authors.lastname: Schmieder
mesh_terms: D000367:Age Factors; D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005650:Fumarates / Q000008:administration & dosage / Q000009:adverse effects; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012084:Renin-Angiotensin System / Q000187:drug effects; D018570:Risk Assessment; D016896:Treatment Outcome; D000092502:Renin Inhibitors
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D005650:Fumarates; D000092502:Renin Inhibitors; C446481:aliskiren