Differential effects of aliskiren/amlodipine combination and high-dose amlodipine monotherapy on endothelial function in elderly hypertensive patients

摘要

Background The aim of this study was to compare the effects of direct renin inhibitor, aliskiren, and amlodipine combination therapy with those of highdose amlodipine monotherapy on endothelial function in elderly hypertensive patients. methods Participants included 105 patients (mean age 77 years) who had receive 5 mg amlodipine for 4 weeks. Patients were allocated to the aliskiren/ amlodipine group (AL/AM) or the high-dose amlodipine (AM) group. The AL/AM group received 150 mg aliskiren in addition to 5 mg amlodipine for 8 weeks; then the dose of aliskiren was doubled to 300 mg for another 8 weeks. The AM group received 10 mg amlodipine for 16 weeks. Of the 105 patients, 87 who underwent measurements of brachial flowmediated vasodilation (FMD) and nitroglycerin-mediated vasodilation (NMD) before and after the study were included in the analysis. results Blood pressure-lowering effects were similar in the 2 groups. Plasma renin activity significantly decreased in the AL/AM group (P < 0.001) but increased in the AM group (P < 0.001). Improvement of FMD was found in the AL/AM group (2.6% to 3.7%, P = 0.001) but not in the AM group, while NMD did not change in either group. The changes in 24-hour systolic blood pressure (r = -0.60, P < 0.001) and diastolic blood pressure (r = -0.46, P = 0.004) were significantly correlated with improvement of FMD in the AL/AM group but not in the AM group. conclusion Addition of aliskiren improved endothelial function in elderly hypertensive patients treated with amlodipine.