Comparative efficacy of aliskiren/valsartan vs valsartan in nocturnal dipper and nondipper hypertensive patients: a pooled analysis
The Journal of Clinical Hypertension, 04/27/2012  Clinical Article

Giles TD et al. – Although the addition of aliskiren to valsartan did not significantly alter dipper status, this data suggest an increased contribution of the renin–angiotensin–aldosterone system to the nondipper status of hypertensive patients.

• This pooled analysis of ambulatory blood pressure (BP) monitoring data from two 8–week randomized controlled trials compared the antihypertensive efficacy and safety of combination aliskiren/valsartan vs valsartan alone in hypertensive patients (nocturnal dippers or nondippers).
• At study end, patients were taking aliskiren/valsartan 300/320 mg or valsartan 320 mg.
• In dippers (n=138) and nondippers (n=132), aliskiren/valsartan provided significantly (P<.05) greater reductions from baseline to week 8 than valsartan in 24–hour, daytime, and last–4–hour mean ambulatory systolic BP (maSBP).
• Treatment differences were more pronounced in nondippers.

• Nighttime maSBP reductions with aliskiren/valsartan were significantly greater vs valsartan in nondippers (–17.0 mm Hg vs –8.9 mm Hg; P<.05) but not dippers (–7.6 mm Hg vs –4.5 mm Hg; P=.16).
• In all time periods, combination therapy was generally associated with BP reductions that were greater in nondippers than dippers.
• Conversion from nondipper to dipper status was 32% vs 22% for aliskiren/valsartan vs valsartan (P=.48).
• Both treatments were similarly well tolerated.