Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 3, Number 4, August 2012, pages 147-153

Aliskiren in Patients Failing to Achieve Blood Pressure Targets With Angiotensin Converting Enzyme Inhibitors or Angiotensin Receptor Blockers

**Table 1.** Minimum Doses of ACEI or ARB Required for Study Inclusion
ACEI	Adequate Daily Dose (mg)	ARBs	Adequate Daily Dose (mg)
Enalapril	20	Candesartan	16
Fosinopril	20	Irbesartan	300
Lisinopril	20	Losartan	100
Ramipril	10	Olmesartan	20
Trandolapril	4	Telmisartan	40
		Valsartan	160

Table 1. Minimum Doses of ACEI or ARB Required for Study Inclusion

ACEI

Adequate Daily Dose (mg)

ARBs

Adequate Daily Dose (mg)

Enalapril

Candesartan

Fosinopril

Irbesartan

300

Lisinopril

Losartan

100

Ramipril

Olmesartan

Trandolapril

Telmisartan

Valsartan

160

**Table 2.** Comorbidities in the 107 Study Patients
Cardiac History
HTN	107 (100%)
MI	34 (32%)
Angina	21 (20%)
PCI/CABG	17 (16%)
HF	11(10%)
PAD	4 (4%)
VHD	3 (3%)
Stroke	3 (3%)
Hyperlipidemia	67 (63%)
Arrhythmias	14 (13%)
Diabetes mellitus	38 (36%)
Thyroid	32 (30%)
Psychiatric	17 (16%)
GI Disease	10 (9%)
Arthritis	11(10%)
COPD/Asthma	11(10%)
Renal disease	6 (6%)

Table 2. Comorbidities in the 107 Study Patients

Cardiac History

HTN

107 (100%)

34 (32%)

Angina

21 (20%)

PCI/CABG

17 (16%)

11(10%)

PAD

4 (4%)

VHD

3 (3%)

Stroke

3 (3%)

Hyperlipidemia

67 (63%)

Arrhythmias

14 (13%)

Non-Cardiac History

Diabetes mellitus

38 (36%)

Thyroid

32 (30%)

Psychiatric

17 (16%)

GI Disease

10 (9%)

Arthritis

11(10%)

COPD/Asthma

11(10%)

Renal disease

6 (6%)

**Table 3.** Treatment Failure With ACEI or ARB Prior to Aliskiren Therapy
ACEI	ARB
Lisinopril	28	22.5	14.1	Candesartan	6	21.3	13.0
Enalapril	8	20.0	15.5	Olmesartan	10	30.0	12.1
Fosinopril	16	28.8	12.5	Telmisartan	3	66.7	12.7
Ramipril	15	11.3	14.4	Valsartan	2	240.0	12.0
Trandolapril	12	8.0	13.3	Irbesartan	5	100.0	11.0
				Losartan	2	300.0	12.6
Total	79				28

Table 3. Treatment Failure With ACEI or ARB Prior to Aliskiren Therapy

ACEI

ARB

Drug

No of pts

Average Dose (mg)

Average Duration of Therapy (weeks)

Drug

No of pts

Average Dose (mg)

Average Duration of Therapy (weeks)

Lisinopril

22.5

14.1

Candesartan

21.3

13.0

Enalapril

20.0

15.5

Olmesartan

30.0

12.1

Fosinopril

28.8

12.5

Telmisartan

66.7

12.7

Ramipril

11.3

14.4

Valsartan

240.0

12.0

Trandolapril

8.0

13.3

Irbesartan

100.0

11.0

Losartan

300.0

12.6

Total

**Table 4.** Additional Therapies Used in Combination With an ACEI or ARB and Aliskiren
Additional antihypertensive therapy	ACEI (n = 73)	ARB (n = 28)
Hydrochlorothiazide (HCTZ)	27	12
Beta-blocker (BB)	20	5
Calcium channel blocker (CCB)	18	6
HCTZ plus BB	4	2
BB plus CCB	3	2
BB plus CCB plus HCTZ	1	1

Table 4. Additional Therapies Used in Combination With an ACEI or ARB and Aliskiren

Additional antihypertensive therapy

ACEI (n = 73)

ARB (n = 28)

Hydrochlorothiazide (HCTZ)

Beta-blocker (BB)

Calcium channel blocker (CCB)

HCTZ plus BB

BB plus CCB

BB plus CCB plus HCTZ

**Table 5.** Time Between Discontinuation of ACEI or ARB Therapy and Initiation of Aliskiren Therapy
Days between therapy	1	2	3	4	5	6	7	8	9
Number of patients	2	12	23	43	6	6	10	3	2

Table 5. Time Between Discontinuation of ACEI or ARB Therapy and Initiation of Aliskiren Therapy

Days between therapy

Number of patients

**Table 6.** BP Response to ACEI or ARB Therapy
	ACE (n = 79)	ARB (n = 28)	Total (n = 107)
Baseline BP (mmHg)	165.4 ± 10.7 103.3 ± 5.2	166.4 ± 10.3 102.7 ± 4.8	165.7 ± 10.6 103.1 ± 5.1
Change in BP (mmHg)	↓8.5 ± 6.3 ↓6.0 ± 4.7	↓8.3 ± 6.7 ↓5.0 ± 5.2	↓8.4 ± 6.4 ↓5.8 ± 4.9
Final BP (mmHg)	156.9 ± 10.3 97.3 ± 4.9	158.1 ± 9.9 97.7 ± 5.1	157.3 ± 10.2 97.1 ± 5.0

Table 6. BP Response to ACEI or ARB Therapy

ACE (n = 79)

ARB (n = 28)

Total (n = 107)

Baseline BP (mmHg)

165.4 ± 10.7
103.3 ± 5.2

166.4 ± 10.3
102.7 ± 4.8

165.7 ± 10.6
103.1 ± 5.1

Change in BP (mmHg)

↓8.5 ± 6.3
↓6.0 ± 4.7

↓8.3 ± 6.7
↓5.0 ± 5.2

↓8.4 ± 6.4
↓5.8 ± 4.9

Final BP (mmHg)

156.9 ± 10.3
97.3 ± 4.9

158.1 ± 9.9
97.7 ± 5.1

157.3 ± 10.2
97.1 ± 5.0

**Table 7.** BP Response to Aliskiren Therapy
BP Response to Aliskiren (n = 107)
Baseline BP (mmHg) (includes background therapy)	161.8 ± 10.8 101.7 ± 6.3
150 mg per day/8.4 wks	155.1 ± 11.3 96.3 ± 6.8	↓6.7 ± 5.4 ↓5.4 ± 4.8
300 mg per day/8.8 wks	153.2 ± 10.9 95.7 ± 6.9	↓8.6 ± 6.3 ↓6.0 ± 4.9

Table 7. BP Response to Aliskiren Therapy

BP Response to Aliskiren (n = 107)

Mean BP (mmHg)

Mean Change in BP

Baseline BP (mmHg)
(includes background therapy)

161.8 ± 10.8
101.7 ± 6.3

150 mg per day/8.4 wks

155.1 ± 11.3
96.3 ± 6.8

↓6.7 ± 5.4
↓5.4 ± 4.8

300 mg per day/8.8 wks

153.2 ± 10.9
95.7 ± 6.9

↓8.6 ± 6.3
↓6.0 ± 4.9