Sustained decrease in blood pressure following missed doses of aliskiren or telmisartan: the ASSERTIVE double-blind, randomized study

Journal of Hypertension, 04/16/2012

Aliskiren showed a greater and more sustained blood pressure (BP)–lowering effect than telmisartan during a 7–day treatment withdrawal. Aliskiren may provide sustained BP lowering during 1 day or more missed dose.


  • Patients were randomized to once–daily aliskiren 150mg (N=414) or telmisartan 40mg (N=408).
  • After 2 weeks, all patients were uptitrated to double the initial dose for 10 weeks; subsequently, all patients were treated with placebo to simulate a 7–day treatment withdrawal.


  • At the end of active treatment (EoA), similar decreases in mean ambulatory BP were observed with aliskiren and telmisartan. From EoA to day 7 of treatment withdrawal (end of withdrawal, EoW), the least squares mean increase in 24–h mean ambulatory SBP was smaller for aliskiren (2.7mmHg) vs. telmisartan (6.5mmHg).
  • Between–treatment difference was significant in favour of aliskiren (–3.8mmHg; P<0.0001).
  • Similar effects were observed for the increase in 24–h mean ambulatory DBP after EoW (–2.1mmHg; P<0.0001).
  • Mean sitting SBP and DBP were also significantly lower with aliskiren than telmisartan after EoW with SBP (2.0mmHg) and DBP (1.1mmHg) differences in favour of aliskiren, already evident on day 2 after a single 'missed dose'.

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