The analysis, which included 396 obese patients and 728 nonobese patients, showed that in obese patients, aliskiren 300 mg monotherapy provided significantly larger BP reductions than hydrochlorothiazide 25 mg monotherapy at week 12 (17/12 vs. 12/9 mm Hg) and aliskiren-based therapy lowered pressure more effectively than hydrochlorothiazide-based therapy at week 52 (20/16 vs. 18/13 mm Hg).

In addition, approximately 60% of obese patients achieved BP control with aliskiren after 12 weeks, and nearly 70% achieved BP control after 52 weeks.

Aliskiren-based therapy produced a similar BP decrease from baseline in obese and nonobese patients. Hydrochlorothiazide-based therapy was significantly less effective in obese patients. “This finding reflects the fact that these patients are relatively resistant to many commonly used antihypertensives,” Dr. Schmieder noted.


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Aliskiren-based therapy was generally well tolerated in obese patients and was associated with a significantly lower incidence of headache than hydrochlorothiazide-based treatment.

The incidence of hypokalemia, a well-known side effect of thiazide diuretics, was significantly lower with aliskiren-based treatment than  hydrochlorothiazide-based treatment in obese patients.

“Hydrochlorothiazide-associated hypokalemia has been linked with metabolic abnormalities and impaired glucose tolerance during long-term therapy as well as with sudden cardiac death and is therefore of particular clinical relevance in obese patients with hypertension,” Dr. Schmieder noted.

Overall, the results show that aliskiren with or without amlodipine is superior to hydrochlorothiazide in obese hypertensive patients, he added.