Long-term effects of aliskiren on blood pressure and the renin-angiotensin-aldosterone system in hypertensive hemodialysis patients

Yoshiyuki Morishita1, Minami Watanabe1, Shiho Hanawa1, Osamu Iimura2, Sadao Tsunematsu3, Kenichi Ishibashi4, Eiji Kusano11Division of Nephrology, Department of Medicine, Jichi Medical University, Tochigi, Japan; 2Kumakura Clinic, Tochigi, Japan; 3Yuki Clinic, Ibaragi, Japan; 4Department of Medical Physiology, Meiji Pharmaceutical University, Tokyo, JapanObjective: The long-term effects of aliskiren in hypertensive hemodialysis patients remain to be elucidated.Design: In this post hoc analysis, we followed up 25 hypertensive hemodialysis patients who completed 8-week aliskiren treatment in a previous study for 20 months to investigate the blood pressure-lowering effect and inhibitory effect on the renin-angiotensin-aldosterone system.Results: Among the 25 patients, eleven patients continued with aliskiren treatment. Blood pressure (± standard deviation) decreased from 175 ± 18/80 ± 11 mmHg at baseline to 156 ± 20/76 ± 9 mmHg at month 20. Plasma renin activity, angiotensin I, and angiotensin II decreased from baseline to month 20 (plasma renin activity (ng/mL/h): 2.3 ± 2.6 to 0.3 ± 0.4 (P < 0.05), angiotensin I (pg/mL): 909.1 ± 902.5 to 41.5 ± 14.8 (P < 0.05), angiotensin II (pg/mL): 41.5 ± 45.8 to 11.0 ± 4.9 (P < 0.05).Conclusion: Long-term treatment with aliskiren provides effective blood pressure lowering and inhibition of the renin-angiotensin-aldosterone system, which are sustained over 20 months in hypertensive hemodialysis patients.Keywords: aliskiren, blood pressure, renin, angiotensin, aldosterone, hemodialysis patients, long-term effect