Initial combination therapy for treatment of hypertension.

摘要

The article by Morris Brown and colleagues (Jan 22, p 312) assesses the initial combination therapy of aliskiren and amlodipine against initial monotherapy of the individual drugs and their sequential add-on regimen. As noted, a doubling of dose for both aliskiren and amlodipine as well as add-on monotherapy resulted in a more effective reduction of systolic or diastolic blood pressure. However, the plausible increase in the risk of cancer, associated with long-term use of aliskiren in combination with amlodipine, is not addressed by the present trial and warrants further investigation. Chronic use of antihypertensive drugs, specifically those that act on the renin-angiotensin-aldosterone system, such as angiotensin-con-verting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), have been implicated in increasing the risk of cancer. These drugs that act via the angiotensin-ll-type 2 receptor kinin cGMP vasodilator-stimulated phosphoprotein pathway (VASP) might augment cancer risk. Aliskiren presents an additional advantage over ACE inhibitors and ARBs, since it inhibits renin directly. It also protects against diabetic retinopathy and obesity that could lead to type 2 diabetes. However, aliskiren, similarly to ACE inhibitors and ARBs, induces a reactive increase in renin secretion, which might concomi-tantly trigger VASP.