Aliskiren/Amlodipine vs. Aliskiren/Hydrochlorothiazide in Hypertension: Indirect Meta-Analysis of Trials Comparing the Two Combinations vs. Monotherapy
Open Access
- 4 December 2013
- journal article
- research article
- Published by Oxford University Press (OUP) in American Journal of Hypertension
- Vol. 27 (2), 268-278
- https://doi.org/10.1093/ajh/hpt210
Abstract
Aliskiren, a direct renin inhibitor, is effective for reducing blood pressure (BP) in patients with hypertension when combined with amlodipine or hydrochlorothiazide (HCTZ). However, the efficacy and tolerability of the 2 combinations are unclear. We performed a meta-analysis of randomized controlled trials of aliskiren/amlodpine and aliskiren/HCTZ for hypertension. The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and the Novartis clinical trial database were searched through December 2012 for reports of randomized controlled trials of aliskiren/amlodpine and aliskiren/HCTZ vs. monotherapy in patients with hypertension. The main outcome measures were reduction in systolic BP and diastolic BP from baseline and rates of therapeutic response and BP control. Tolerance of aliskiren/amlodipine and aliskiren/HCTZ was also analyzed. Outcomes were initially pooled by standard random-effects methods, producing a weighted mean difference (WMD) or risk ratio (RR) and 95% confidence intervals (CIs). The pooled estimates were then used for adjusted indirect comparisons. We selected 19 reports of trials involving 13,614 participants. Aliskiren/amlodpine and aliskiren/HCTZ were more effective than monotherapy in controlling BP. Aliskiren/amlodipine was significantly more effective than aliskiren/HCTZ in reducing systolic BP (WMD = −3.36mm Hg; 95% CI = −4.64 to 2.07mm Hg) and diastolic BP (WMD = −3.49mm Hg; 95% CI = −4.34 to 2.63mm Hg). As compared with aliskiren/HCTZ, alikiren/amlodipine was associated with higher rate of therapeutic response (RR = 1.23; 95% CI = 1.14–1.33) and BP control (RR = 1.24; 95% CI = 1.11–1.39). Number of adverse events and withdrawals due to adverse events were similar with aliskiren/amlodipine and aliskiren/HCTZ. BP control is better with aliskiren combined with amlodipine or HCTZ than with monotherapy, with aliskiren/amlodipine being more effective than aliskiren/HCTZ.Keywords
This publication has 34 references indexed in Scilit:
- 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC)Journal Of Hypertension, 2013
- Comparison of Aliskiren/Hydrochlorothiazide Combination Therapy and Amlodipine Monotherapy in Patients With Stage 2 Systolic Hypertension and Type 2 Diabetes MellitusThe Journal of Clinical Hypertension, 2011
- Comparison of Aliskiren/Hydrochlorothiazide Combination Therapy With Hydrochlorothiazide Monotherapy in Older Patients With Stage 2 Systolic Hypertension: Results of the ACTION StudyThe Journal of Clinical Hypertension, 2011
- Aliskiren Alone or in Combination With Hydrochlorothiazide in Patients With the Lower Ranges of Stage 2 Hypertension: The ACQUIRE Randomized Double‐Blind StudyThe Journal of Clinical Hypertension, 2010
- Combination Therapy With Various Combinations of Aliskiren, Valsartan, and Hydrochlorothiazide in Hypertensive Patients Not Adequately Responsive to Hydrochlorothiazide AloneThe Journal of Clinical Hypertension, 2009
- Direct Renin Inhibition With Aliskiren in Obese Patients With Arterial HypertensionHypertension, 2007
- Effectiveness of Add-On Low-Dose Diuretics in Combination Therapy for Hypertension: Losartan/Hydrochlorothiazide vs. Candesartan/AmlodipineHypertension Research, 2007
- Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureHypertension, 2003
- Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Controlled Clinical Trials, 1996