Table 1.
Summary of studies.
| First Author | Year/Country Study Type | Arms | Participants | Main Findings |
|---|---|---|---|---|
| Stanton A. [22] | 2003 Ireland RCT | ALI 37.5; 75; 150; 300; LOS 100 | 226 Mild-to-moderate hypertension | Dose-dependent reductions in ambulatory BP and decreased PRA were observed with ALI. Changes following 75, 150, and 300 mg of ALI were not significantly different to those observed with 100 mg of LOS. |
| Gradman A.H. [23] | 2005 USA RCT | ALI 150; 300; 600; IRB 150; Placebo | 652 Mild-to-moderate hypertension | Oral ALI showed an effective BP lowering effect. ALI 300 and 600 mg lowered msDBP significantly more than IRB 150 mg. ALI 150 mg had a similar antihypertensive effect to IRB 150 mg. |
| Kushiro T. [24] | 2006 Japan RCT | ALI 75; 150; 300; Placebo | 455 Japanese Mild-to-moderate hypertension | Once-daily oral ALI provided significant, dose-dependent reductions in msSBP/DBP with placebo-like tolerability in Japanese patients with hypertension. |
| Pool J.L. [25] | 2007 Multicenter RCT | ALI 75; 150; 300; VAL 80; 120; 360; ALI/VAL; VAL/HCTZ; Placebo | 1123 Mild-to-moderate hypertension | ALI monotherapy produced dose-related reductions in DBP/SBP similar to VAL monotherapy and placebo-like tolerability. The combination of the two showed additive results with similar tolerability. |
| O’Brien E. [26] | 2007 Ireland RCT | ALI 150; RAM 5; IRB 150; ALI/HCTZ; ALI/RAM; ALI/IRB | 67 Mild-to-moderate hypertension | ALI combined with HCTZ, RAM, or IRB, demonstrated significantly greater BP reductions than any agent monotherapy and also neutralized the compensatory rise in PRA stimulated by the other antihypertensive agents. |
| Jordan J. [27] | 2007 Multicenter RCT | ALI/HCTZ; AML/HCTZ; IRB/HCTZ; Placebo/HCTZ | 489 Obese Mild-to-moderate hypertension | ALI/HCTZ showed significantly greater BP reductions than HCTZ alone, but similar to AML/HCTZ and IRB/HCTZ in obese hypertensive individuals. The ALI combination also neutralized the compensatory rise in PRA. |
| Strasser R.H. [28] | 2007 Multicenter RCT | ALI 300; LIS 40; ALI/HCTZ; LIS/HCTZ | 153 Severe hypertension | ALI 300 mg monotherapy or ALI/HCTZ combination demonstrated similar efficacy and tolerability to LIS 40 mg monotherapy or LIS/HCTZ combination respectively in patients with severe hypertension. |
| Verdecchia P. [29] | 2007 Multicenter RCT | ALI 75; 150; 300; LIS 10 | 355 (≥65 years old) Mild-to-moderate hypertension | ALI 75/150/300 mg and LIS 10mg lowered ambulatory SBP and office msSBP with no significant difference between ALI doses and no evidence of dose-related increases in the incidence of AEs. |
| Oh B.H. [19] | 2007 Multicenter RCT | ALI 150; 300; 600; Placebo | 672 Mild-to-moderate hypertension | ALI 150 to 600 mg once daily, provided significant antihypertensive efficacy and placebo-like tolerability. The lowering effect of ALI 600 mg was greater but not statistically significant of that of ALI 300 mg. |
| Drummond W. [30] | 2007 Multicenter RCT | AML 5; 10; ALI/AML | 545 Mild-to-moderate hypertension | ALI/AML 150/5 mg demonstrated greater BP lowering efficacy than AML 5 mg monotherapy but similar to AML 10 mg, although less edema was noted with the combination treatment. |
| Oparil S. [31] | 2007 Multicenter RCT | ALI 300; VAL 320; ALI/VAL; Placebo | 1797 Mild-to-moderate hypertension | ALI/VAL 300/320 mg significantly lowered msDBP as compared to either component monotherapy or placebo. Safety and tolerability profiles were similar in all groups. |
| Uresin Y. [32] | 2007 Multicenter RCT | ALI 300; RAM 10; ALI/RAM | 837 DM Mild-to-moderate hypertension | ALI 300 mg provided additional, significant BP reductions when combined with RAM 10 mg in patients with hypertension and diabetes mellitus. |
| Villamil A. [33] | 2007 Multicenter RCT | ALI 75; 150; 300; HCTZ 6.25; 12.5; 25; ALI/HTCZ; Placebo | 2776 Mild-to-moderate hypertension | ALI/HCTZ combination produced a greater reduction in BP measurements and achieved better control rates and more responders than either monotherapy. HCTZ monotherapy increased PRA, but PRA decreased in the ALI monotherapy and the combination groups |
| Andersen K. [34] | 2008 Iceland RCT | ALI 300; RAM 10; ALI/HCTZ; RAM/HCTZ | 687 Mild-to-moderate hypertension | ALI based therapy, alone or with HCTZ, produced greater msSBP/DBP reductions, better control rates, and more sustained effects after drug discontinuation than RAM based therapy. |
| Dietz R. [35] | 2008 Multicenter RCT | ALI 300; ATEN 100; ALI/ATEN | 694 Mild-to-moderate hypertension | ALI/ATEN induced significantly greater msSBP reductions than ALI or ATEN alone, and msDBP reductions were larger with ATEN than with ALI. All three regimens reduced mean PRA from baseline. ALI treatment had lower rates of AEs and was not associated with bradycardia. |
| Nickenig G. [36] | 2008 Multicenter RCT | ALI 300; ALI/HCTZ | 880 Non-responders to ALI monotherapy Mild-to-moderate hypertension | ALI/HCTZ 300/25 mg and 300/12.5 mg produced significantly greater msSBP/DBP reductions from baseline as well as higher BP control rates than ALI 300 mg alone with similar tolerability. |
| Geiger H. [37] | 2009 Multicenter RCT | HCTZ 25; ALI/HCTZ; VAL/HCTZ; ALI/VAL/HCTZ | 641 Non-responders to HCTZ monotherapy; Mild-to-moderate hypertension | The ALI/VAL/HCTZ 300/320/25 mg arm produced statistically significant additional reductions in SBP/DBP and higher control rates than the ALI/HCTZ 300/25 mg, VAL/HCTZ 320/25 mg combinations and the HCTZ 25 mg monotherapy. The safety profile of the triple combination was similar to that of the double combinations. |
| Kushiro T. [38] | 2009 Multicenter RCT | ALI 300; ALI/diuretic; ALI/CCB | 345 Japanese Mild-to-moderate hypertension | ALI monotherapy, as well as combinations of ALI/diuretic and ALI/CCB, achieved clinically significant msSBP/DBP reductions. All regimens were well tolerated, and the overall responder rate was high. |
| Puig J.G. [39] | 2009 Multicenter RCT | ALI 75; 150; 300; Placebo | 642 Mild-to-moderate hypertension | Dose-related BP reductions were observed with ALI 75, 150, and 300 mg, but only the reductions achieved with ALI 150 and 300 mg were statistically significant compared to placebo. All doses were well tolerated. |
| Blumenstein M. [40] | 2009 Multicenter RCT | HCTZ 25; ALI/HCTZ 150/25; 300/25 | 722 Non-responders to HCTZ monotherapy; Mild-to-moderate hypertension | Single pill ALI/HCTZ 300/25 mg and 150/25 mg combinations significantly lowered msSBP/DBP with the 300/25 mg combination producing the greater reductions. Responder rates were also significantly higher with ALI/HCTZ combinations. ALI/HCTZ showed similar tolerability to HCTZ monotherapy and a numerically lower incidence of hypokalemia. |
| Littlejohn T.W. III [41] | 2009 Multicenter Non RCT | ALI/AML 300/10 ± HCTZ | 556 Mild-to-moderate hypertension | ALI/AML 300/10 mg, with or without add-on HCTZ, effectively reduced BP, especially in patients with stage 2 hypertension. The most common AE was peripheral edema. |
| Schmieder R.E. [42] | 2009 Multicenter RCT | ALI 300; HCTZ 25; Placebo ± AML | 1124 Mild-to-moderate hypertension | ALI based therapy produced significantly greater BP reductions and higher responder rates than HCTZ based therapy. AE rates were similar in all groups with hypokalemia being more frequent in HCTZ based therapy. |
| Duprez D.A. [43] | 2010 USA RCT | ALI 300; RAM 10 ± HCTZ or AML | 901 (≥65 years old) Mild-to-moderate hypertension | ALI monotherapy in elders with essential hypertension showed greater msSDB/DBP reductions and higher control rates than RAM monotherapy. Also fewer patients required add-on treatment with HCTZ or AML. Tolerability was similar, but the RAM group had a higher incidence of cough. |
| Black H.R. [44] | 2010 Multicenter RCT | ALI 300; ALI/HCTZ | 688 160 mm Hg ≤ SBP < 180 mm Hg | ALI 300 mg monotherapy, as well as ALI/HCTZ 300/25 mg, produced substantial BP reductions from baseline with the reductions being significantly greater in the combination therapy. |
| Ito S. [45] | 2010 Japan Non RCT | ALI 75→300 | 40 Japanese Renal dysfunction; Mild-to-moderate hypertension | 65% of the patients achieved BP response and 30% BP control with ALI monotherapy. The AE profile was low, and similar to studies with hypertensive patients without renal dysfunction. |
| Chrysant S.G. [46] | 2010 Multicenter Non RCT | ALI/VAL 300/320 ± HCTZ | 601 Mild-to-moderate hypertension | ALI/VAL 300/320 mg with or without optional HCTZ addition showed clinically significant BP-lowering effects, high BP control rates and was well-tolerated with a very low incidence of hyperkalemia in patients with hypertension. |
| Palatini P. [47] | 2010 Multicenter RCT | ALI 300; IRB 300; RAM 10 | 654 Mean ambulatory DBP ≥ 85 mm Hg | ALI 300 mg provided similar BP-lowering effects with IRB 300 mg and significantly greater than RAM 10 mg. The maintenance of the mean ambulatory SBP/DBP lowering effect of ALI was significantly greater when compared to both IRB and RAM monotherapies. |
| Fogari R. [48] | 2010 Italy RCT | ALI 300; LOS 100 | 76 Metabolic syndrome Mild-to-moderate hypertension | Both ALI 300 mg and LOS 100 mg induced a significant and similar SBP/DBP reduction. tPA activity decreased with LOS and did not change significantly with ALI. Insulin sensitivity was also improved with ALI and remained unchanged with LOS. |
| Weir M.R. [49] | 2010 Multicenter RCT | ALI 300 + ≥ 200 mmol/d Na; ALI 300 + ≤ 100 mmol/d Na | 132 135 mm Hg ≤ SBP < 160 mm Hg | During ALI 300 mg treatment, ambulatory SBP was significantly lower with the low-sodium diet compared to the high-sodium diet. Responder rates were also significantly higher with the low sodium diet. |
| Ferdinand K.C. [50] | 2011 USA RCT | ALI/AML/HCTZ 300/10/25; ALI/AML 300/10 | 412 US minority Stage 2 hypertension | ALI/AML/HCTZ 300/10/25 mg produced greater msSBP reductions and higher responder rates than ALI/AML 300/10 mg therapy in self-identified US minority patients. Both combinations showed similar tolerability |
| Fogari R. [51] | 2011 Italy RCT | ALI 300; AML 10; ALI/AML | 120 Mild-to-moderate hypertension | ALI 300 mg and AML 10 mg monotherapies produced similar SBP/DBP reductions. Their combination induced greater BP reductions than both monotherapies and a lower increase in ankle-foot volume than AML monotherapy. PRA was unaffected by AML, and it was reduced by both ALI monotherapy and ALI/AML combination. |
| Basile J. [52] | 2011 USA RCT | ALI/HCTZ 300/25; HCTZ 25 ± AML | 451 (≥55 years old) 160 mm Hg ≤ SBP < 200 mm Hg | ALI/HCTZ 300/25 mg therapy provides significantly greater BP reductions and higher control rates than HCTZ 25 mg monotherapy with or without the optional addition of AML in older patients with stage 2 hypertension. |
| Townsend R.R. [53] | 2011 USA RCT | ALI/HCTZ 300/25; AML 10 | 860 DM 160 mm Hg ≤ SBP < 200 mm Hg | ALI/HCTZ 300/25 mg produced greater msSBP reductions and higher control rates than AML 10 mg. msDBP reductions were similar in both groups. Both treatments were well tolerated, although AE incidence and discontinuation were higher in the AML group. |
| Brown M.J. [54] | 2011 Multicenter RCT | ALI/Placebo; AML/Placebo; ALI/AML | 1254 150 mm Hg ≤ SBP < 180 mm Hg | ALI/AML 300/10 mg treatment showed higher SBP reductions than either monotherapy. ALI/AML combination could be recommended for initial treatment for BP ≥ 150 mm Hg. |
| Sica D. [55] | 2011 Multicenter RCT | ALI 150; 300 ± HCTZ | 1955 Mild-to-moderate hypertension | Long-term treatment with ALI with or without additional HCTZ is well tolerated and provides effective BP reductions that are sustained over one year. |
| Ferdinand K.C. [56] | 2011 USA RCT | ALI/HCTZ 300/25; AML 10 | 332 160 mm Hg ≤ SBP < 200 mm Hg | ALI/HCTZ 300/25 mg and AML 10 mg produced similar msSBP/DBP and 24-h ambulatory SBP reductions. Central SBP reductions, measured in a smaller subgroup, were greater in the ALI/HCTZ arm. BP control rates were similar in both groups. |
| Segura J. [57] | 2011 Spain Non RCT | ALI/AML/CHLOR 300/10/50 | 76 Treatment-resistant hypertension | ALI/AML/CHLOR 300/10/50 mg treatment showed effective BP lowering effects in patients with treatment-resistant hypertension not responding to spironolactone. |
| Black H.R. [58] | 2011 USA RCT | ALI/AML 300/10; AML 10 | 443 African American 160 mm Hg ≤ SBP < 200 mm Hg | ALI/AML 300/10 mg produced greater msSBP reductions and higher responder rates than AML 10 mg monotherapy. |
| Krone W. [59] | 2011 Multicenter RCT | ALI 300; IRB 300 | 141 Hypertension and Metabolic syndrome | ALI 300 mg provided significantly greater BP reductions and higher control rates than IRB 300 mg. Both treatments had similar effects on lipid and glucose profiles. |
| Drummond W. [60] | 2011 USA RCT | VAL/HCTZ/ALI 160/25/300; VAL/HCTZ/Placebo | 363 DM msDBP ≥ 95 mm Hg inadequately controlled with VAL/HCTZ | BP reductions with ALI 300 mg added to VAL/HCTZ 160/25 mg were numerically greater compared with placebo added to VAL/HCTZ, but not statistically significant. |
| Schweizer J. [61] | 2011 Germany Non RCT | ALI/HCTZ 300/25 ± AML | 123 100 mm Hg ≤ DBP < 110 mm Hg inadequately controlled with CAN/HCTZ | Patients inadequately controlled with CAN/HCTZ 32/25 mg achieved clinically and statistically significant BP reductions with the single pill combination of ALI /HCTZ 300/25 mg and the optional addition of AML 5 mg. |
| Zhu J.R. [62] | 2012 Multicenter RCT | ALI 75; 150; 300; RAM 5 | 1316 Asian Mild-to-moderate hypertension | ALI in doses of 75,150, and 300 mg produced greater BP reductions and higher control rates than RAM 5 mg, but only the differences with ALI 300 mg were statistically significant. |
| Flack J.M. [63] | 2012 Multicenter RCT | ALI/VAL 300/320; VAL 320 | 451 Stage 2 hypertension | ALI/VAL 300/320 mg significantly reduced msSBP than VAL 320 mg alone. Even greater differences were observed in 24-h ambulatory BP measurements in a small subgroup of 76 patients. |
| Düsing R. [64] | 2012 Multicenter RCT | ALI 300; TEL 80 | 822 Essential hypertension | ALI 300 mg and TEL 80 mg produced similar mean ambulatory SBP reductions. During a seven-day treatment withdrawal, ALI showed a more sustained BP-lowering effect than TEL. |
| Axthelm C. [65] | 2012 Multicenter Non RCT | ALI/AML 300/10 ± HCTZ | 342 Stage 2 hypertension Not controlled by OLM/AML 40/10 mg | ALI/AML 300/10 mg with the optional addition of HCTZ 12.5 mg achieved clinically and statistically significant BP reductions in patients inadequately controlled by OLM/AML 40/10 mg. |
| Fogari R. [66] | 2012 Italy RCT | ALI 300; AML 10; Placebo | 170 DM (50–75 years old) Mild-to-moderate hypertension | ALI and AML both, significantly reduced SBP/DBP with no statistical difference between them. Only ALI reduced QT duration and dispersion. |
| Pfeiffer D. [67] | 2012 Multicenter RCT | ALI/AML 300/10; 150/10; AML 10 | 847 Mild-to-moderate hypertension Not controlled by AML monotherapy | ALI/AML 300/10 and 150/10 mg provided significantly greater msSBP/DBP reductions than AML 10 mg monotherapy. Higher control rates were achieved in the ALI/AML 300/10 mg arm over the AML 10 mg arm. |
| Villa G. [68] | 2012 Multicenter RCT | ALI 75; 150; 300; Placebo | 754 (≥65years old) 150 mm Hg ≤ msSBP < 180 mm Hg | ALI 75, 150, and 300 mg provided significantly greater msSBP/DBP reductions compared to placebo. The estimated minimum effective dose was 81.9 mg. |
| Lacourcière Y. [69] | 2012 Multicenter RCT | ALI/AML/HCTZ; ALI/AML; ALI/HCTZ; AML/HCTZ | 1191 Moderate-to-severe hypertension | ALI/AML/HCTZ 300/10/25 mg produced statistically superior msSBP/DBP reductions and higher control rates as compared to the ALI/AML, ALI/HCTZ, and AML/HCTZ dual combinations. |
| Murray A.V. [70] | 2012 Multicenter Non RCT | ALI/AML/HCTZ 300/10/25 | 564 Moderate-to-severe hypertension | ALI/AML/HCTZ 300/10/25 mg provided statistically significant msSBP/DBP reductions, high BP control rates and was well tolerated. |
| Glorioso N. [71] | 2012 Multicenter RCT | ALI/AML 300/10; 300/5; ALI 300 | 818 Mild-to-moderate hypertension | ALI/AML 300/10 and 300/5 mg provided significantly greater msSBP/DBP reductions and higher BP control rates than ALI 300 mg alone. |
| Braun-Dullaeus R.C. [72] | 2012 Multicenter RCT | ALI/AML 300/10; AML 10 | 485 Moderate-to-severe hypertension | ALI/AML 300/10 mg produced significantly greater msSBP/DBP reductions and BP control rates than AML 10 mg monotherapy. Both groups had a similar incidence of AEs. |
| Kanaoka T. [73] | 2012 Japan Non RCT | ALI 150→300 | 21 Nondiabetic Japanese Mild-to-moderate hypertension | ALI 300 mg significantly reduced clinic, ambulatory and central BP measurements. Brachial-ankle pulse wave velocity, a marker of arterial stiffness, also significantly decreased from baseline. |
| Littlejohn T.W. III [74] | 2013 Multicenter RCT | ALI 150; 300; AML 5; 10; ALI/AML; Placebo | 1688 95 mm Hg ≤ msDBP < 110 mm Hg | ALI/AML (150 or 300 mg)/ (5 or 10 mg) combinations provided greater BP reductions than either agent alone. |
| Mazza A [75] | 2013 Italy Non RCT | ALI 150–300 | 106 Resistant hypertension Mild renal dysfunction | ALI 150–300 mg significantly reduced clinic and ambulatory BP measurements, left ventricular mass index and did not affect eGFR. |
| Bakris G.L. [76] | 2013 USA RCT | ALI/VAL 300/320; VAL 320 | 1143 DM Hypertension Stage 1 or 2 CKD | ALI/VAL 300/320 mg provided additive BP reductions and similar tolerability to VAL 320 mg alone in diabetic patients with early stage CKD. |
| Yoshitomi Y. [77] | 2013 Japan Non RCT | ALI 150 add-on | 43 Resistant hypertension | ALI 150 mg added to the existing regimen provided greater BP control rates and was effective as a fourth or fifth line agent. |
| Andreadis E.A. [78] | 2014 Greece RCT | ALI 300; RAM 5± HCTZ or AML | 154 Naïve or 6 mo untreated | ALI based therapy produced similar SBP/DBP reductions to RAM based therapy. Both therapies reduced the ambulatory arterial stiffness index. |
| Imbalzano E. [79] | 2015 Italy RCT | ALI add-on; RAM or LOS add-on | 126 DM Microalbuminuria Uncontrolled BP | ALI addition to optimal therapy provided higher BP and microalbuminuria reductions compared with the addition of RAM or LOS. |
| Mizuno H. [80] | 2016 Japan RCT | ALI/AML 150–300/5; AML 10 | 105 Japanese elderly Essential hypertension | ALI/AML 150–300/5 mg and AML 10 mg produced similar reductions in 24-h SBP, and daytime/nighttime SBP. ALI/AML significantly reduced UACR more than high dose AML, but it was significantly less effective in reducing morning BP surge and early morning BP. |
| Tani S. [81] | 2016 Japan Non RCT | ALI add-on | 79 Uncontrolled BP | ALI addition to existing regimens provided higher control rates and made it possible to reduce the number of drugs in treatment combinations. No renal function worsening was observed in patients receiving other RAAS inhibitors. |