Aliskiren Reduces Morning Blood Pressure in Hypertensive Patients with Diabetic Nephropathy on Hemodialysis

Abstract

Our previous study indicated that the exchange from an angiotensin receptor blocker (ARB) to aliskiren reduced morning blood pressure and albuminuria in hypertensive patients with diabetic nephropathy. We extended the above study and assessed the effects of exchanging from an ARB to aliskiren on home blood pressure in hypertensive patients with diabetic nephropathy on chronic hemodialysis. The patients who were persistently hypertensive despite antihypertensive therapy, including ARB, were considered as candidates for the exchange from the ARB to aliskiren. Patients’ age and durations of diabetes and hemodialysis were averaged as 62 ± 9 years old, 15 ± 8 and 7 ± 3 years, respectively. Aliskiren decreased morning systolic blood pressure (149 ± 14 to 144 ± 13 mm Hg, n = 30, P < .01) and plasma renin activity (3.5 ± 1.1 to 1.2 ± 0.6 ng/mL/h, P < .01) without changes in serum potassium. Aliskiren also reduced interdialytic weight gain (2.7 ± 0.6 to 2.5 ± 0.5 kg/interval, P < .05) and attenuated the magnitude of intradialytic declines in systolic (−20 ± 11 to −17 ± 10 mm Hg, P < .05) and diastolic blood pressure (−9 ± 6 to −5 ± 5 mm Hg, P < .01). The exchange from an ARB to aliskiren is safe and useful to control home blood pressure in hypertensive hemodialysis patients with diabetic nephropathy. Aliskiren reduced both intradialytic blood pressure drops and interdialytic weight gain in patients with DN.

• diabetes
• home blood pressure
• nitric oxide
• thirst
• renin–angiotensin system

ACKNOWLEDGMENTS

We thank Ms. Sachiko Nakazato for her sincere help during the preparation of the manuscript. Our department received research grants from Takeda Pharmaceutical Co. Ltd., Daiichi Sankyo Co. Ltd., Kyowa Hakko Kirin Co. Ltd., Chugai Pharmaceutical Co. Ltd., Pfizer Co. Ltd., Novartis International AG, Merck & Co. Inc., Astellas Pharma Inc., Taisho-Toyama Pharmaceutical Co. Ltd., Omron Healthcare Co. Ltd., Dainippon-Sumitomo Pharma Co. Ltd. and Bayer Pharmaceutical Co. Ltd. Parts of the data were presented at the annual meeting of the Japanese Society of Dialysis, Sapporo Hokkaido, Japan, in June 2012, and published as an abstract.

Declaration of interest

The authors report no conflicts of interest regarding this manuscript. The authors alone are responsible for the content and writing of the paper.