Department of Biomedicine, Pharmacology, Aarhus University, Aarhus C, Denmark.
Department of Renal Medicine, Aarhus University Hospital, Aarhus C, Denmark.
J Hum Hypertens. 2019 Nov;33(11):795-806. doi: 10.1038/s41371-018-0149-8. Epub 2019 Jan 10.
The role of the direct renin inhibitor aliskiren in hypertension is not fully established and use of aliskiren in diabetic patients is especially controversial. A systematic review investigating both short-term diastolic and systolic blood pressure (DBP and SBP) reduction and long-term cardiovascular outcomes has not been conducted. Therefore, we aimed to fill this gap by investigating BP reduction, major cardiovascular outcomes, and mortality of aliskiren compared to other antihypertensive therapy. We searched PubMed and Embase databases for relevant randomized controlled trials (RCTs). Using a random-effects model, weighted mean difference (WMD) and relative risk (WRR) with 95% confidence interval (CI) were used to measure the effect of aliskiren therapy in the management of hypertension and major cardiovascular outcomes. Thirty seven RCTs with a total of 35,916 patients were included. Aliskiren induced slightly greater DBP and SBP reductions than other antihypertensive agents (WMD -0.77 mmHg, 95% CI [-2.01;0.46 mmHg] and WMD -1.14 mmHg, 95% CI [-2.78;0.50 mmHg], respectively). Aliskiren did not reduce total mortality or cardiovascular death. In patients with diabetes, aliskiren add-on therapy may have the potential to increase total mortality and cardiovascular death (WRR 1.06, 95% CI [0.88;1.28] and WRR 1.09, 95% CI [0.94;1.24], respectively). Despite superior BP-reducing effect, aliskiren is not recommended as first-line treatment in hypertensive patients as it does not reduce mortality and major cardiovascular outcomes. Dual renin-angiotensin-aldosterone system inhibition with aliskiren should be avoided in diabetic patients, while the use of aliskiren monotherapy remains to be investigated.
直接肾素抑制剂阿利吉仑在高血压中的作用尚未完全确定，其在糖尿病患者中的应用尤其存在争议。尚未进行系统评价来研究短期舒张压和收缩压（DBP 和 SBP）降低以及长期心血管结局。因此，我们旨在通过研究与其他降压治疗相比阿利吉仑的降压效果、主要心血管结局和死亡率来填补这一空白。我们检索了 PubMed 和 Embase 数据库中的相关随机对照试验（RCT）。使用随机效应模型，加权均数差（WMD）和相对风险（WRR）及其 95%置信区间（CI）用于测量阿利吉仑治疗在高血压和主要心血管结局管理中的效果。共纳入 37 项 RCT，总计 35916 例患者。阿利吉仑诱导的 DBP 和 SBP 降低略大于其他降压药物（WMD -0.77mmHg，95%CI [-2.01;0.46mmHg]和 WMD -1.14mmHg，95%CI [-2.78;0.50mmHg]）。阿利吉仑并未降低总死亡率或心血管死亡率。在糖尿病患者中，阿利吉仑的附加治疗可能会增加总死亡率和心血管死亡（WRR 1.06，95%CI [0.88;1.28]和 WRR 1.09，95%CI [0.94;1.24]）。尽管降压效果较好，但阿利吉仑不推荐作为高血压患者的一线治疗药物，因为它不能降低死亡率和主要心血管结局。应避免在糖尿病患者中使用阿利吉仑双重肾素-血管紧张素-醛固酮系统抑制，而阿利吉仑单药治疗的效果仍有待研究。
