Influence of diabetes on efficacy of aliskiren, losartan or both on left
ventricular mass regression.
Author(s): Vardeny O, Pouleur AC, Takeuchi M, Appelbaum E, Verma A, Prescott M, Smith B,
Dahlof B, Solomon SD; ALLAY Investigators.
Affiliation(s): University of Wisconsin School of Pharmacy, Madison, WI 53705-2222, USA.
ovardeny@pharmacy.wisc.edu
Publication date & source: 2012, J Renin Angiotensin Aldosterone Syst. , 13(2):265-72
HYPOTHESIS/ INTRODUCTION: We investigated whether diabetes modified the
effectiveness of renin-angiotensin-aldosterone system (RAAS) inhibition on left
ventricular hypertrophy (LVH) regression in hypertensive patients in the
Aliskiren in Left Ventricular Hypertrophy (ALLAY) trial.MATERIALS AND METHODS:
Participants (n=465) with LVH and a BMI > 25 kg/m(2) were randomized to aliskiren
300mg, losartan 100mg or both daily for 36 weeks, and LVH regression was assessed
by cardiac magnetic resonance imaging. Renin concentration, plasma renin activity
and aldosterone were assessed in a subset of patients.
RESULTS: Patients with diabetes mellitus (DM) (n=111, 24%) were older (61±9 vs.
58±11 years, p=0.03), had higher BMI (32.2±4.2 vs. 30.7 ± 4 kg/m(2), p=0.004),
higher systolic blood pressure (148±14 vs. 145±14mmHg, p=0.03) and lower eGFR
(79±16 vs. 84±16ml/min, p=0.03) at baseline. Combination therapy with aliskiren
plus losartan was associated with greater LVH reduction than losartan alone in
patients with DM (p=0.01), but not in patients without DM (p=0.91; unadjusted
interaction p=0.06; adjusted p = 0.038). In a subset of 138 participants, plasma
aldosterone was reduced to a greater extent in patients with DM (p-interaction =
0.004).
CONCLUSIONS: Patients with DM and LVH may derive differential benefit with dual
RAAS inhibition with a combination of aliskiren and losartan compared with
losartan alone with respect to LVH reduction. Whether these findings will result
in improved outcomes will be further explored in larger studies.
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