News | September 09, 2013

Medication Does Not Slow Progression of Coronary Disease in Patients with Prehypertension

September 9, 2013 -- Among patients with prehypertension and coronary artery disease, use of the renin (an enzyme secreted by the kidneys) inhibitor aliskiren, compared with placebo, did not result in improvement or slowing in the progression of coronary atherosclerosis, according to a study published by JAMA. The study was released early online to coincide with its presentation at the European Society of Cardiology Congress 2013.

According to background information in the article, “guidelines recommend blood pressure reduction in patients with hypertension with a treatment goal of 140 mm Hg for systolic and 90 mm Hg diastolic blood pressure for most individuals. The benefit of additional blood pressure lowering agents in patients who have reached treatment goals has not been established. However, few trials have examined the benefits and risks of further intensifying blood pressure treatment in patients with established coronary artery disease (CAD), who are in the prehypertension range. Preclinical data demonstrate that renin-angiotensin-aldosterone system (RAAS) activation plays an important role in atherosclerosis and that RAAS inhibition may have a direct beneficial effect on the artery wall. Blood pressure reduction and RAAS inhibition are targets for treatment of atherosclerosis. The effect of renin inhibition on coronary disease progression has not been investigated.”

Stephen J. Nicholls, M.B.B.S., Ph.D., of the South Australian Health and Medical Research Institute in Adelaide, Australia, and colleagues conducted a study to determine if renin inhibition with aliskiren would slow progression of coronary atherosclerosis in patients whose blood pressure was considered optimally controlled to current treatment targets. The randomized, multicenter trial compared aliskiren with placebo in 613 participants with coronary artery disease, systolic blood pressure between 125 and 139 mm Hg (prehypertension range), and two additional cardiovascular risk factors. The trial was conducted at 103 academic and community hospitals in Europe, Australia, and North and South America with enrollment from March 2009 to February 2011. The end of follow-up was January 2013.

Participants underwent coronary intravascular ultrasound (IVUS) imaging and were randomized to receive 300 mg of aliskiren (n=305) or placebo (n=308) daily for 104 weeks. Disease progression was measured by repeat IVUS examination after at least 72 weeks of treatment, with evaluable imaging data available at follow-up in 74.7 percent of patients (225 in the aliskiren group and 233 in the placebo group). The primary efficacy parameter was the change in percent atheroma (a fatty deposit) volume (PAV) from baseline to study completion.

The researchers found that there was no difference between the treatment groups with respect to measures of atheroma burden at baseline. The primary efficacy measure, PAV, decreased by 0.33 percent in the aliskiren group and increased by 0.11 percent in the placebo group. The between-group difference was -0.43 percent. There were no significant differences in the proportion of participants who demonstrated regression of PAV (56.9 vs. 48.9 percent) and total atheroma volume (64.4 vs. 57.5 percent) in the aliskiren and placebo groups, respectively.

A greater number of discontinuations of participation due to adverse events were observed in the aliskiren group compared with the placebo group (8.2 vs. 4.5 percent, respectively).

“These findings do not support the use of aliskiren for regression or prevention of progression of coronary atherosclerosis,” the authors conclude. The study was funded by Novartis Pharmaceuticals. 

For more information: media.jamanetwork.com

Related Content

Lexington Begins HeartSentry Clinical Trial
News | Clinical Study | February 20, 2018
February 20, 2018 – Lexington Biosciences, Inc., a development-stage medical device company, announced the commenceme
Endologix Completes Patient Enrollment in the ELEVATE IDE Clinical Study
News | Clinical Study | February 06, 2018
February 6, 2018 – Endologix, a developer and marketer of treatments for aortic disorders, announced the completion o
12-Month Results from Veryan Medical's MIMICS-2 IDE Study Presented at LINC
News | Clinical Study | February 01, 2018
February 1, 2018 – Thomas Zeller (Bad Krozingen, Germany) presented the 12-month results from Veryan Medical’s MIMICS
LimFlow Completes U.S. Feasibility Study Enrollment, Receives FDA Device Status
News | Clinical Study | February 01, 2018
February 1, 2018 –  LimFlow SA, developer of minimally-inv
ESC 2017 late breaking trial hot line study presentations.
News | Clinical Study | September 12, 2017
September 12, 2017 – The European Society of Cardiology (ESC) Congress 2017 includes several Hot Line Late-breaking C
U.K., NHS studies, weekend effect, hospital admission, atrial fibrillation, heart failure
News | Clinical Study | June 28, 2016
New research shows patients admitted to National Health Service (NHS) hospitals in the United Kingdom for atrial...
stroke risk
News | Clinical Study | August 28, 2015
Most people assume strokes only happen to octogenarians, but recent evidence suggests that survivors of childhood can
Overlay Init