Blood Pressure Lowering of Aliskiren Hydrochlorothiazide (HCTZ) Versus Amlodipine in Stage 2 Hypertension in African Americans (ATLAAST)

• Change in Mean Sitting Diastolic Blood Pressure (MSDBP) After 8 Weeks of Treatment [ Time Frame: Baseline and 8 weeks ] [ Designated as safety issue: No ]
  To assess the change from baseline in mean sitting diastolic blood pressure (MSDBP) after 8 weeks of treatment with an aliskiren HCTZ-based treatment regimen (aliskiren HCTZ 150/12.5 mg, 300/25 mg) versus an amlodipine-based treatment regimen (amlodipine 5 mg, 10 mg) in African American patients with stage 2 hypertension.
• Change in Mean Sitting Pulse Pressure (MSPP) After 8 Weeks of Treatment [ Time Frame: Baseline and 8 weeks ] [ Designated as safety issue: No ]
  To compare the change from baseline in mean sitting pulse pressure (MSPP) after 8 weeks of treatment with an aliskiren HCTZ-based treatment regimen (aliskiren HCTZ 150/12.5 mg, 300/25 mg) versus an amlodipine-based treatment regimen (amlodipine 5 mg, 10 mg) in African American patients with stage 2 hypertension.
• Percentage of Responders After 8 Weeks of Treatment. [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
  To compare the percentage of responders after 8 weeks of treatment with an aliskiren HCTZ based treatment regimen (aliskiren HCTZ 150/12.5 mg, 300/25 mg) versus an amlodipine-based treatment regimen (amlodipine 5 mg, 10 mg) in African American patients with stage 2 hypertension: [ Responders were defined as patients with MSSBP < 140 mm Hg or a decrease from baseline ≥ 20 mm Hg at 1st response. A response was counted when a patient first achieved MSSBP < 140 mm Hg or a decrease from baseline ≥ 20 mm Hg.]
• Percentage of Participants Achieving BP Control After 8 Weeks of Treatment [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
  To compare the percentage of patients achieving BP control (<140/90 mm Hg) after 8 weeks of treatment with an aliskiren HCTZ-based treatment regimen (aliskiren HCTZ 150/12.5 mg, 300/25 mg) versus an amlodipine-based treatment regimen (amlodipine 5 mg, 10 mg) in African American patients with stage 2 hypertension.

• Change in MSDBP after 8 weeks of treatment [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
• Change in mean sitting pulse pressure after 8 weeks of treatment [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
• Proportion of responders after 8 weeks of treatment. [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
• Proportion of patients achieving BP control after 8 weeks of treatment [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
• Safety and tolerability of aliskiren HCTZ versus Amlodipine [ Time Frame: 8 weeks ] [ Designated as safety issue: Yes ]

The purpose of the study is to evaluate the efficacy and safety of a fixed dose combination of aliskiren HCTZ versus amlodipine in African American patients with Stage 2 hypertension.

• Drug: Aliskiren Hydrochlorothiazide (HCTZ): 8 weeks
  Aliskiren HCTZ (150/12.5 mg) for 1 week followed by forced titration to Aliskiren HCTZ (300/25 mg) for remaining 7 weeks
• Drug: Amlodipine: 8 weeks
  Amlodipine 5 mg for 1 week followed by forced titration to Amlodipine 10 mg for remaining 7 weeks

• Experimental: Aliskiren Hydrochlorothiazide (HCTZ)
  Intervention: Drug: Aliskiren Hydrochlorothiazide (HCTZ): 8 weeks
• Active Comparator: Amlodipine
  Intervention: Drug: Amlodipine: 8 weeks

Inclusion Criteria:

• Patients who are eligible and able to participate in the study, and who give written informed consent before any assessment is performed.
• Men or women 18 years and older of African American background; self identified
• Patients with stage 2 hypertension. Patients must have a MSSBP ≥ 160 mmHg and < 200 mmHg at Visit 5 (randomization)

Exclusion Criteria:

• Office blood pressure measured by cuff (MSSBP ≥ 200 mmHg and/or MSDBP ≥ 110 mmHg) at any visit.
• Use of other investigational drugs at the time of enrollment, or within 30 days or 5 half-lives whichever is longer.
• History of hypersensitivity to any of the study drugs or to drugs belonging to the same therapeutic class (CCBs or thiazide diuretics) as the study drugs.
• Long QT syndrome or QTc > 450 msec for males and > 470 msec for females at screening.
• History of malignancy of any organ system (other than localized basal cell carcinoma of the skin), treated or untreated, within the past 5 years, regardless of whether there is evidence of local recurrence or metastases.
• Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test (> 5 mIU/mL)

• Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant. including women whose career, lifestyle, or sexual orientation precludes intercourse with a male partner and women whose partners have been sterilized by vasectomy or other means, UNLESS they are using two birth control methods. The two methods can be a double barrier method or a barrier method plus a hormonal method.

  1. Adequate barrier methods of contraception include: diaphragm, condom (by the partner), intrauterine device (copper or hormonal), sponge or spermicide. Hormonal contraceptives include any marketed contraceptive agent that includes an estrogen and/or a progestational agent. Reliable contraception should be maintained throughout the study and for 7 days after study drug discontinuation.
  2. Women are considered post-menopausal and not of child bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or six months of spontaneous amenorrhea with serum FSH levels > 40 mIU/mL [and estradiol < 20 pg/mL] or have had surgical bilateral oophorectomy (with or without hysterectomy) at least six weeks ago. In the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment.
• History or evidence of a secondary form of hypertension.
• Known Keith-Wagener Grade III or IV hypertensive retinopathy.
• History of cerebrovascular accident, transient ischemic cerebral attack (TIA), heart failure (NYHA Class II-IV), myocardial infarction, coronary bypass surgery, or any percutaneous coronary intervention (PCI) in the last 12 months.
• Current angina pectoris requiring pharmacological therapy.
• Other protocol-defined inclusion/exclusion criteria may apply