title: Effects of treatment withdrawal on brachial and central aortic pressure after direct renin inhibition or angiotensin receptor blockade.
abstract: BACKGROUND
  Whilst sustained lowering of brachial systolic blood pressure (Br-SBP) and central aortic systolic pressure (CASP) have been demonstrated in patients with hypertension, effects of treatment withdrawal on these parameters have not been investigated. The ASSERTIVE study previously reported more sustained control of Br-SBP with aliskiren versus telmisartan in patients with hypertension, following 7-days treatment withdrawal. In this ASSERTIVE sub-study, we hypothesised that aliskiren would similarly exert more sustained control of CASP than telmisartan during treatment withdrawal.
  
  
  METHODS
  We investigated the effects of treatment withdrawal on both Br-SBP and CASP following 12-weeks treatment with either aliskiren (300 mg) or telmisartan (80 mg). Br-SBP and CASP were measured at the end of treatment, and at days 2 and 7 following treatment withdrawal in 303 patients (CASP randomised set).
  
  
  RESULTS
  Of the CASP randomised set, 94 patients completed CASP measurements at all time points (CASP completer set). After 7 days of treatment withdrawal, aliskiren demonstrated lesser increases in both Br-SBP and CASP than telmisartan; Br-SBP change: -2.0±1.6 vs. +5.6±1.7 mmHg, p = 0.001; CASP change: -0.4±1.6 vs. +4.6±1.7 mmHg, p = 0.041, n = 94. Similar findings were obtained for the CASP randomised set.
  
  
  CONCLUSIONS
  Following treatment withdrawal, aliskiren demonstrated more sustained control of both brachial and central SBP than telmisartan.
authors.affiliation: Institute of Cardiovascular Science and National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, UK.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Lacy
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Brunel
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bader
authors.affiliation: Institute of Cardiovascular Science and National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Jones
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Fabio
authors.initials: F
authors.lastname: Baschiera
authors.affiliation: Hypertoniezentrum Bonn, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Düsing
authors.affiliation: Institute of Cardiovascular Science and National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, UK bryan.williams@ucl.ac.uk.
authors.forename: Bryan
authors.initials: B
authors.lastname: Williams
mesh_terms: D000450:Aldosterone / Q000097:blood; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology*; D001011:Aorta / Q000187:drug effects*; D062186:Arterial Pressure / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects; D001916:Brachial Artery / Q000187:drug effects*; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood; D016896:Treatment Outcome; D028761:Withholding Treatment; D000092502:Renin Inhibitors
chemical_list: D000450:Aldosterone; D057911:Angiotensin Receptor Antagonists; D012083:Renin; D000092502:Renin Inhibitors
keywords: Aliskiren; angiotensin receptor blockade; central aortic pressure; direct renin inhibition; telmisartan; treatment withdrawal