NEW YORK—A combination of aliskiren and hydrochlorothiazide (HCTZ) is an effective first-line treatment option for older patients with stage 2 hypertension, even those with diabetes or metabolic syndrome, investigators concluded.

After four weeks of treatment, patients treated with the dual regimen experienced significant decreases in systolic blood pressure (BP) from baseline, and these decreases were significantly greater than achieved with HCTZ alone. In addition, significantly more patients receiving the combination achieved a target BP below 140/90 mm Hg, regardless of whether they had diabetes or metabolic syndrome.

A team led by Jan Basile, MD, Professor of Medicine at the Medical University of South Carolina in Charleston, arrived at these findings from a post hoc subgroup analysis of patients enrolled in the ACTION (Aliskiren HCTZ in Older Patients with Stage 2 Hypertension) study. The eight-week trial enrolled 451 patients aged 55 years and older with a mean sitting systolic BP of 160 mm Hg or greater but less than 200 mm Hg. Researchers randomized 228 patients to receive aliskiren/HCTZ 300/25 mg and 223 to receive HCTZ (25 mg).

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Among the patients with diabetes or metabolic syndrome, the mean decrease in systolic BP from baseline to week 4 was 27.9 mm Hg in the aliskiren/HCTZ treated patients versus a decrease of 20.8 mm Hg in the HCTZ-only group, a significant difference between the groups, Dr. Basile’s group reported at the American Society of Hypertension annual meeting. Among subjects without diabetes or metabolic syndrome, the mean decrease in systolic BP was 30.8 mm Hg in the combination arm compared with 23.7 mm Hg in the monotherapy group.

At four weeks, the proportion of patients achieving a BP target of less than 140/90 mm Hg was significantly greater with aliskiren/HCTZ than HCTZ alone among patients with metabolic syndrome or diabetes (47.1% vs. 34.6%) and among those without metabolic syndrome or diabetes (53.6% vs. 32.2%).