Comparison of the effectiveness of aliskiren and ramipril for the management of hypertension: A systematic review and meta-analysis

Objective: Ramipril is an important option in the management of hypertension, while the role of aliskiren is still up for debate. We aim to meta-analyse and compare the effect of aliskiren with ramipril by measuring mean difference in systolic blood pressure (mdSBP) and mean difference in diastolic blood pressure (mdDBP).

Methods: The search was conducted using the PubMed and Cochrane databases for eligible randomized clinical trials (RCTs) to perform a meta-analysis from January 2000 to May 2024. RCTs that included hypertensive patients who were under either aliskiren or ramipril treatment were included in the analysis. The risk of bias was evaluated using RoB 2.0. This study is registered with PROSPERO: CRD42024577105.

Results: Four studies were included: two studies were carried out for 2 months, and two were carried out for 6 months, including 693 and 329 patients, respectively, with mild to moderate hypertension and a mean age of 55.2 years. After 2 months, mdDBP was found to be significant (mdDBP=0.85mmHg, 95% CI: 0.73-0.97, I²=0%), but mdSBP was found to be non-significant (mdSBP=0.0mmHg, 95% CI: -0.17-0.17, I²=0%). There was a significant difference in the mdSBP (mdSBP=3.15mmHg, 95% CI: 2.13-4.17, I²=84%) and mdDBP (mdDBP=1.2mmHg, 95% CI: 1.09-1.31, I²=0%) at 6 months.

Conclusion: Aliskiren provides, in the short term, a slight improvement in BP in non-elderly hypertensive patients without diabetes or previous cardio-cerebrovascular disease.