Aliskiren Therapy In Hypertension And Cardiovascular Disease:A Systematic Review And A Meta-Analysis

Background:It is controversial for whether aliskiren is more clinically effective and safe than angiotensin converting enzyme inhibitors(ACEIs)or angiotensin receptor blockers(ARBs).Methods:We searched the Cochrane Central Register,the Clinical Trials Registry,EMBASE,MEDLINE and PubMed for relevant literatures up to January 2017.We used the Review Manager(version 5.3)and STATA statistical software(version 12.0)for statistical analysis.Effects(weighted mean difference,relative risk)were incorporated by using fixed or random effects models.Subgroup analysis and sensitivity analysis were used to explore the sources of heterogeneity,as well as risk and publication bias in this study.Results:Our study included 13 trials involving 13,624 patients.The results showed that compared with ACEIs/ARBs,there was no significant difference in the antihyperte-nsive effects between aliskiren and ACEIs/ARBs,among which systolic blood pressure(SBP)[weighted mean difference(WMD)0.32;95% confidence interval(CI)-1.30 to-1.93],diastolic blood pressure(DBP)0.50;95% CI-0.92 to-1.91),as well as the risk of hyperkalaemia [RR 1.14;95%CI 0.69 to 1.90] and renal impairment(RR1.42;95%CI 0.58 to 3.48);To be compared with aliskiren monother-apy,aliskiren in combination therapy with ACEIs or ARBs was able to better reduce SBP(WMD-4.01;95%CI-6.10 to-1.92)and DBP(WMD-2.54;95% CI-4.12 to-0.97),but with significantly increased the risk of hyperkalaemia(RR 1.86;95% CI 1.23 to2.82).Aliskiren in combination therapy with ACEIs or ARBs had remarkable effects in reducing systolic blood pressure(SBP)(WMD-4.20;95%CI-5.44 to-2.97)and diastolic blood pressure(DBP: WMD-2.09;95%CI-2.90 to-1.27)when compared with ACEIs or ARBs monotherapy,but with significantly increased the risk of hyperkalaemia(RR 1.40;95%CI 1.23 to 1.58)and kidney injury(RR 1.79;95%CI1.06 to 3.02).Besides,there was no significant difference in the incidence of total mortality and major cardiovascular events between the combined therapy and ACEIs or ARBs monotherapy(RR 0.95;95%CI 0.87 to 1.04).Conclusion:Aliskiren in combination therapy with ACEs/ARBs significantly reduced BP,but increased the risk of hyperkalemia and renal injury,and failed to improve the overall mortality and the occurrence of major cardiovascular events.