Aliskiren-based stepped-care treatment algorithm provides effective blood pressure control

Aims: Recent guidelines for the management of hypertension recommend an individualised stepped‐care treatment approach in mild‐to‐moderate hypertensive patients, to achieve blood pressure (BP) goals. This study evaluated the probability of patients achieving BP targets with an aliskiren‐based stepped‐care treatment regimen. Methods: This was a 24‐week, open‐label, non‐comparator study design that included six sequential 4‐week treatment periods in patients with mild‐to‐moderate hypertension. Over the potential 24 weeks of active treatment, incremental therapy included the following add‐on therapies at 4‐week intervals: aliskiren 150–300 mg once daily, hydrochlorothiazide (HCTZ) 12.5–25 mg once daily, and finally amlodipine 5–10 mg once daily, as needed to achieve target BP. Subjects achieving BP targets following any given 4 weeks of therapy were considered study completers, while subjects not achieving their clinical BP target entered into the next step of incremental therapy. The primary efficacy end‐point was the estimated cumulative probability of patients achieving BP target. Results: Of 256 patients treated, 232 (90.6%) completed the study. Baseline mean sitting BP was 155.7/91.7 mmHg. At study end‐point, the estimated cumulative probability of reaching BP target was 86.12%. The stepped‐care treatment regimen was well tolerated at the maximal recommended doses of all the individual complimentary therapies. Conclusion: An aliskiren‐based stepped‐care treatment regimen that subsequently included both HCTZ and amlodipine is effective in achieving BP goals in approximately 90% of patients with mild‐to‐moderate hypertension.