Aliskiren Plus Valsartan Reduces Blood Pressure More Than Either Agent Alone

The oral renin inhibitor aliskiren was recently approved by the FDA for treatment of hypertension, as monotherapy or in combination with other drugs. Aliskiren blocks the renin-angiotensin-aldosterone (RAA) system at an earlier step than angiotensin-converting–enzyme inhibitors or angiotensin-receptor blockers (ARBs). Combinations of ACE inhibitors and ARBs have not been consistently more effective than either drug alone. Might a combination of aliskiren and an ARB lower blood pressure more effectively than either agent alone?

Researchers randomized 1797 hypertensive patients (mean diastolic pressure, 95–110 mm Hg) to receive half-maximal doses of aliskiren, valsartan, both, or placebo for 8 weeks, with titration to maximal doses. The study …