Comparative efficacy of aliskiren/valsartan vs valsartan in nocturnal dipper and
nondipper hypertensive patients: a pooled analysis.
Author(s): Giles TD, Alessi T, Purkayastha D, Zappe D.
Affiliation(s): Heart and Vascular Institute, Tulane University School of Medicine, New Orleans,
LA 70005, USA. tgiles4@cox.net
Publication date & source: 2012, J Clin Hypertens (Greenwich). , 14(5):299-306
This pooled analysis of ambulatory blood pressure (BP) monitoring data from two
8-week randomized controlled trials compared the antihypertensive efficacy and
safety of combination aliskiren/valsartan vs valsartan alone in hypertensive
patients (nocturnal dippers or nondippers). At study end, patients were taking
aliskiren/valsartan 300/320 mg or valsartan 320 mg. In dippers (n=138) and
nondippers (n=132), aliskiren/valsartan provided significantly (P<.05) greater
reductions from baseline to week 8 than valsartan in 24-hour, daytime, and
last-4-hour mean ambulatory systolic BP (maSBP). Treatment differences were more
pronounced in nondippers. Nighttime maSBP reductions with aliskiren/valsartan
were significantly greater vs valsartan in nondippers (-17.0 mm Hg vs -8.9 mm Hg;
P<.05) but not dippers (-7.6 mm Hg vs -4.5 mm Hg; P=.16). In all time periods,
combination therapy was generally associated with BP reductions that were greater
in nondippers than dippers. Conversion from nondipper to dipper status was 32% vs
22% for aliskiren/valsartan vs valsartan (P=.48). Both treatments were similarly
well tolerated. Although the addition of aliskiren to valsartan did not
significantly alter dipper status, our data suggest an increased contribution of
the renin-angiotensin-aldosterone system to the nondipper status of hypertensive
patients.
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