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Effect of aliskiren on progression of coronary disease in patients with prehypertension: the AQUARIUS randomized clinical trial.
JAMA. 2013 Sep 18; 310(11):1135-44.JAMA

Abstract

IMPORTANCE

Blood pressure reduction and renin-angiotensin-aldosterone system inhibition are targets for treatment of atherosclerosis. The effect of renin inhibition on coronary disease progression has not been investigated.

OBJECTIVE

To determine the effects of renin inhibition with aliskiren on progression of coronary atherosclerosis.

DESIGN, SETTING, AND PARTICIPANTS

A double-blind, randomized, multicenter trial (Aliskiren Quantitative Atherosclerosis Regression Intravascular Ultrasound Study) comparing aliskiren with placebo in 613 participants with coronary artery disease, systolic blood pressure between 125 and 139 mm Hg (prehypertension range), and 2 additional cardiovascular risk factors conducted at 103 academic and community hospitals in Europe, Australia, and North and South America (enrollment from March 2009 to February 2011; end of follow-up: January 31, 2013).

INTERVENTIONS

Participants underwent coronary intravascular ultrasound (IVUS) imaging and were randomized to receive 300 mg of aliskiren (n = 305) or placebo (n = 308) taken orally daily for 104 weeks. Disease progression was measured by repeat IVUS examination after at least 72 weeks of treatment.

MAIN OUTCOMES AND MEASURES

The primary efficacy parameter was the change in percent atheroma volume (PAV) from baseline to study completion. Secondary efficacy parameters included the change in normalized total atheroma volume (TAV) and the percentage of participants with atheroma regression. Safety and tolerability were also assessed.

RESULTS

Evaluable imaging data were available at baseline and follow-up for 458 participants (74.7%). The primary IVUS efficacy parameter, PAV, did not differ between participants treated with aliskiren (-0.33%; 95% CI, -0.68% to 0.02%) and placebo (0.11%; 95% CI, -0.24% to 0.45%) (between-group difference, -0.43% [95% CI, -0.92% to 0.05%]; P = .08). The secondary IVUS efficacy parameter, TAV, did not differ between participants treated with aliskiren (-4.1 mm3; 95% CI, -6.27 to -1.94 mm3) and placebo (-2.1 mm3; 95% CI, -4.21 to 0.07 mm3) (between-group difference, -2.04 mm3 [95% CI, -5.03 to 0.95 mm3]; P = .18). There were no significant differences in the proportion of participants who demonstrated regression of PAV (56.9% vs 48.9%; P = .08) and TAV (64.4% vs 57.5%; P = .13) in the aliskiren and placebo groups, respectively.

CONCLUSIONS AND RELEVANCE

Among participants with prehypertension and coronary artery disease, the use of aliskiren compared with placebo did not result in improvement or slowing of progression of coronary atherosclerosis. These findings do not support the use of aliskiren for regression or prevention of progression of coronary atherosclerosis.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00853827.

Authors+Show Affiliations

South Australian Health and Medical Research Institute, Adelaide, Australia. stephen.nicholls@sahmri.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23999933

Citation

Nicholls, Stephen J., et al. "Effect of Aliskiren On Progression of Coronary Disease in Patients With Prehypertension: the AQUARIUS Randomized Clinical Trial." JAMA, vol. 310, no. 11, 2013, pp. 1135-44.
Nicholls SJ, Bakris GL, Kastelein JJ, et al. Effect of aliskiren on progression of coronary disease in patients with prehypertension: the AQUARIUS randomized clinical trial. JAMA. 2013;310(11):1135-44.
Nicholls, S. J., Bakris, G. L., Kastelein, J. J., Menon, V., Williams, B., Armbrecht, J., Brunel, P., Nicolaides, M., Hsu, A., Hu, B., Fang, H., Puri, R., Uno, K., Kataoka, Y., Bash, D., & Nissen, S. E. (2013). Effect of aliskiren on progression of coronary disease in patients with prehypertension: the AQUARIUS randomized clinical trial. JAMA, 310(11), 1135-44. https://doi.org/10.1001/jama.2013.277169
Nicholls SJ, et al. Effect of Aliskiren On Progression of Coronary Disease in Patients With Prehypertension: the AQUARIUS Randomized Clinical Trial. JAMA. 2013 Sep 18;310(11):1135-44. PubMed PMID: 23999933.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of aliskiren on progression of coronary disease in patients with prehypertension: the AQUARIUS randomized clinical trial. AU - Nicholls,Stephen J, AU - Bakris,George L, AU - Kastelein,John J P, AU - Menon,Venu, AU - Williams,Bryan, AU - Armbrecht,Juergen, AU - Brunel,Patrick, AU - Nicolaides,Maria, AU - Hsu,Amy, AU - Hu,Bo, AU - Fang,Hui, AU - Puri,Rishi, AU - Uno,Kiyoko, AU - Kataoka,Yu, AU - Bash,Dianna, AU - Nissen,Steven E, PY - 2013/9/4/entrez PY - 2013/9/4/pubmed PY - 2013/9/24/medline SP - 1135 EP - 44 JF - JAMA JO - JAMA VL - 310 IS - 11 N2 - IMPORTANCE: Blood pressure reduction and renin-angiotensin-aldosterone system inhibition are targets for treatment of atherosclerosis. The effect of renin inhibition on coronary disease progression has not been investigated. OBJECTIVE: To determine the effects of renin inhibition with aliskiren on progression of coronary atherosclerosis. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized, multicenter trial (Aliskiren Quantitative Atherosclerosis Regression Intravascular Ultrasound Study) comparing aliskiren with placebo in 613 participants with coronary artery disease, systolic blood pressure between 125 and 139 mm Hg (prehypertension range), and 2 additional cardiovascular risk factors conducted at 103 academic and community hospitals in Europe, Australia, and North and South America (enrollment from March 2009 to February 2011; end of follow-up: January 31, 2013). INTERVENTIONS: Participants underwent coronary intravascular ultrasound (IVUS) imaging and were randomized to receive 300 mg of aliskiren (n = 305) or placebo (n = 308) taken orally daily for 104 weeks. Disease progression was measured by repeat IVUS examination after at least 72 weeks of treatment. MAIN OUTCOMES AND MEASURES: The primary efficacy parameter was the change in percent atheroma volume (PAV) from baseline to study completion. Secondary efficacy parameters included the change in normalized total atheroma volume (TAV) and the percentage of participants with atheroma regression. Safety and tolerability were also assessed. RESULTS: Evaluable imaging data were available at baseline and follow-up for 458 participants (74.7%). The primary IVUS efficacy parameter, PAV, did not differ between participants treated with aliskiren (-0.33%; 95% CI, -0.68% to 0.02%) and placebo (0.11%; 95% CI, -0.24% to 0.45%) (between-group difference, -0.43% [95% CI, -0.92% to 0.05%]; P = .08). The secondary IVUS efficacy parameter, TAV, did not differ between participants treated with aliskiren (-4.1 mm3; 95% CI, -6.27 to -1.94 mm3) and placebo (-2.1 mm3; 95% CI, -4.21 to 0.07 mm3) (between-group difference, -2.04 mm3 [95% CI, -5.03 to 0.95 mm3]; P = .18). There were no significant differences in the proportion of participants who demonstrated regression of PAV (56.9% vs 48.9%; P = .08) and TAV (64.4% vs 57.5%; P = .13) in the aliskiren and placebo groups, respectively. CONCLUSIONS AND RELEVANCE: Among participants with prehypertension and coronary artery disease, the use of aliskiren compared with placebo did not result in improvement or slowing of progression of coronary atherosclerosis. These findings do not support the use of aliskiren for regression or prevention of progression of coronary atherosclerosis. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00853827. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/23999933/Effect_of_aliskiren_on_progression_of_coronary_disease_in_patients_with_prehypertension:_the_AQUARIUS_randomized_clinical_trial_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2013.277169 DB - PRIME DP - Unbound Medicine ER -