Aliskiren in patients with diabetes: a systematic review.
Author(s): Rizos EC, Agouridis AP, Elisaf MS.
Affiliation(s): Department of Internal Medicine, Medical School, University of Ioannina,
Ioannina, Greece.
Publication date & source: 2012, Curr Vasc Pharmacol. , 10(2):140-6
Objective: Diabetic patients are at risk of macro- and micro-vascular
complications, including diabetic nephropathy, and have difficulties in achieving
blood pressure (BP) goals. Aliskiren, a direct renin inhibitor, inhibits the
first step of the renin angiotensin aldosterone system. We aimed to
systematically address the relevant evidence on the effects of aliskiren in
diabetic individuals. Methods: We considered randomized controlled trials (RCTs)
evaluating aliskiren in diabetic patients. Information was recorded independently
by 2 investigators. We were limited to trials published in English. Results:
PubMed search retrieved 16 items. After excluding 12, we ended with 4 eligible
studies with 1488 participants. Mean baseline BP levels were 143/82 mmHg and
median follow up was 2 months. Aliskiren was compared against angiotensin
converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) or aliskiren
plus ACE inhibitor/ARB in 2 studies and against placebo in the other 2. The most
frequent indication for aliskiren therapy was diabetes plus hypertension and
albuminuria. Aliskiren seems to be effective in reducing BP levels, albuminuria
in diabetics, either as monotherapy (compared with placebo), or in addition to
ACE inhibitors/ARB (compared with monotherapy), without any major safety
considerations. Conclusions: There are promising results on the effect of
aliskiren in diabetic patients, but the available evidence is limited so far.
This is a poorly investigated field with few RCTs and new studies focusing on
"hard" outcomes are needed.
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