Aims: To compare the effect of the direct renin inhibitor aliskiren on neurohumoral activity in heart failure patients treated with low-dose and high-dose ACE inhibitor.
Methods: A retrospective analysis of the ALOFT trial. Comparison of the effects of 6 months treatment with aliskiren (versus placebo) in patients receiving <guideline-recommended dose of ACE inhibitor (n = 109) with those receiving ≥ recommended-dose (n = 81). Neurohumoral measures included B-type natriuretic peptide (BNP), NT proBNP, plasma renin activity and urinary aldosterone excretion.
Results: Patients in each ACE inhibitor-dose group were generally similar (those in the ≥ recommended ACE inhibitor-dose had higher baseline blood-pressures and LVEF and were more often female and diabetic). In the <recommended-dose sub-group, the reduction in BNP from baseline to end-of-study was -1% (95% CI -32 to +44%) in the placebo-group and -32% (-1 to -53%) in the aliskiren group. The corresponding reductions in the ≥recommended ACE inhibitor-dose sub-group were: placebo -19% (-46 to +22%) and aliskiren -46% (-22 to -62%); interaction p-value 0.94. The pattern of results for other neurohumoral markers was similar.
Conclusions: Aliskiren causes neurohumoral suppression in heart failure, even in patients treated with ≥recommended-dose of ACE inhibitor.