Background: In view of the potential benefit of direct renin inhibition, this post-marketing survey was undertaken to assess blood pressure lowering and target blood pressure attainment in 905 patients with and without metabolic syndrome and with body mass indices of ≥30 kg/m
2 treated with aliskiren or aliskiren/ hydrochlorothiazide in the primary care setting. In addition, tolerability and the prior treatment were assessed.
Methods: A t an initial v isit, physicians assessed blood pressure, heart rate, risk factors, signs of end organ damage and prior antihypertensive medication. Patients were prescribed aliskiren or aliskiren/hydrochlorothiazide. Efficacy and tolerability were measured by assessing blood pressure, heart rate and side effects at a further visit after two months. Blood pressure targets were defined according to the guidelines of the Swiss Society of Hypertension.
Results: Mean sitting systolic blood pressure/mean sitting diastolic blood pressure was lowered equally effectively (systolic/diastolic:
p = 1.0/0.8) in patients with (–22.0 ± 15.3/–11.1 ± 8.7 mm Hg) and without metabolic syndrome (–22.0 ± 15.8/–10.9 ± 9.6 mm Hg), while target blood p ressure attainment was significantly lower in patients with metabolic syndrome (35% vs. 48%;
p <0.001). In contrast, blood pressure was lowered to a significantly greater extent in obese subjects (body mass index ≥30 kg/m
2; –23.6 ± 16.4/–12.1 ± 9.6 mm Hg) compared to patients with body mass index <30 kg/m
2 (–21.2 ± 15.1/–10.5 ± 9.1 mm Hg,
p = 0.03/ 0.02) and the blood pressure control rate in this group was non-significantly higher (45.3% vs. 39.4%,
p = 0.09). Side effects were reported in 1.8% of all cases, none of them severe. The treatment approach of physicians before the initial visit did not differ b etween patients with/without metabolic syndrome.
Conclusions: A liskiren and aliskiren/hydrochlorothiazide are effective in patients regardless of their metabolic situation. However, low blood pressure control rates suggest that more than two antihypertensive agents are needed to control blood pressure adequately in these high risk patients.
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