Aliskiren in an alternate-day administration schedule in hypertensive albuminuric patients.

Objective It has been suggested that aliskiren has a longhalf-life and maintains a blood pressure (BP)-loweringeffect following a missed dose. We tested the hypothesisthat every otherday (eod) administration of aliskiren has thesame effects as the once daily (od) dosing in albuminurichypertensive patients.Methods Fifteen hypertensive patients, after a 4-weekwash-out period on clonidine, received 300mg aliskiren odas the sole treatment. In patients who remained out oftarget, other nonrenin–angiotensin system blockers wereadded. Patients who completed a 24-week (w24) treatmentperiod were switched to eod administration of aliskiren foran additional period of 24 weeks (w48).Results Thirteenpatients completed the full study protocol.The mean office BP was reduced at the end of w24(−9/3mmHg), a reduction that continued to be observedat w48 (−11/1mmHg). At the end of the study, the 48hambulatory BP monitoring was divided into two 24hperiods. The mean 24h systolic BP, and the mean daytimesystolic and diastolic BP were significantly lower (P<0.05)in the first 24h (when aliskiren was taken) compared withthe second period. Central hemodynamics showed nosignificant differences at any time during monitoring.Administration of aliskiren resulted in a median reductionof urine albumin/creatinine ratio of 103mg/g (od) and102mg/g (eod). Differences in plasma renin activity, plasmarenin concentration, and aldosterone-level measurementswere not significant.Conclusion The BP-lowering effect of eod aliskirenadministration, although adequate, is less efficientcompared with od administration, despite the fact thatin terms of reducing albuminuria, it appears to beeffective. Blood Press Monit 19:359–365 © 2014Wolters Kluwer Health | Lippincott Williams & Wilkins.