An Extension Study to Evaluate the Long Term Safety, Tolerability and Efficacy of Aliskiren Compared to Enalapril in Pediatric Hypertensive Patients 6-17 Years of Age

• Mean sitting systolic blood pressure reduction of long-term administration of aliskiren compared to enalapril in hypertensive children aged 6-17 years old [ Time Frame: 52 weeks ] [ Designated as safety issue: No ]
• Evaluate the efficacy as assessed by calculated mean arterial pressure (MAP), of long-term administration of aliskiren compared to enalapril in hypertensive children 6 to 17 years old [ Time Frame: 52 weeks ] [ Designated as safety issue: No ]
• Mean sitting diastolic blood pressure reduction of long-term administration of aliskiren compared to enalapril in hypertensive children aged 6-17 years old [ Time Frame: 52 weeks ] [ Designated as safety issue: No ]

The purpose of this study is to evaluate in a randomized, double-blind fashion, the long-term safety, tolerability and efficacy profile of aliskiren compared to the active comparator enalapril in children, 6 - 17 years old with hypertension (msSBP ≥ 95th percentile for age, gender and height, at baseline in study CSPP100A2365). Patients will be randomized to receive either aliskiren or enalapril. Weight-group based doses of aliskiren or enalapril will be administered once daily and children will receive study medication in a double-blind manner. This study is being conducted to support monotherapy registration of aliskiren for the treatment of hypertension in pediatric patients 6-17 years of age (age at baseline in Study CSPP100A2365).

• Drug: Aliskiren

  Low weight patients: Starting dose 37.5 mg with optional titration to 75 and then 150 mg

  Mid weight patients: Starting dose 75 mg with optional titration to 150 and then 300 mg

  High weight patients: Starting dose 150 mg with optional titration to 300 and then 600 mg

• Drug: Enalapril

  Low weight patients: Starting dose 2.5 mg with optional titration to 5 and then 10 mg

  Mid weight patients: Starting dose 5 mg with optional titration to 10 and then 20 mg

  High weight patients: Starting dose 10 mg with optional titration to 20 and then 40 mg

• Active Comparator: Enalapril

  Patients will receive one of the following doses based on the their weight:

  Low weight patients: Starting dose 2.5 mg with optional titration to 5 and then 10 mg

  Mid weight patients: Starting dose 5 mg with optional titration to 10 and then 20 mg

  High weight patients: Starting dose 10 mg with optional titration to 20 and then 40 mg

  Intervention: Drug: Enalapril
• Experimental: Aliskiren

  Patients will receive one of the following doses based on the their weight:

  Low weight patients: Starting dose 37.5 mg with optional titration to 75 and then 150 mg

  Mid weight patients: Starting dose 75 mg with optional titration to 150 and then 300 mg

  High weight patients: Starting dose 150 mg with optional titration to 300 and then 600 mg

  Intervention: Drug: Aliskiren

Inclusion Criteria:

• msSBP (mean of 3 systolic blood pressure measurements) must be ≥ 95th percentile for age, gender and height, at Visit 2 (randomization), in study CSPP100A2365
• Must be ≥ 20 kg and ≤ 150 kg at Visit 2 (randomization), in study CSPP100A2365
• Must be able to swallow minitablets (2mm in diameter) administered in soft food
• Successful completion of Phase 1 (dose response phase) and at least 1 week of Phase 2 (placebo withdrawal phase) of the CSPP100A2365 protocol, with no serious drug-related adverse event(s).

Exclusion Criteria:

• Patient receiving immunosuppressant medication (e.g. cyclosporine, MMF, etc) other than oral/topical steroids, for any medical condition
• Current diagnosis of heart failure (NYHA Class II-IV) or history of cardiomyopathy or obstructive valvular disease
• msSBP ≥ 25% above the 95th percentile
• Second or third degree heart block without a pacemaker
• AST/SGOT or ALT/SGPT >3 times the upper limit of the reference range
• Total bilirubin > 2 times the upper limit of the reference range
• Creatinine clearance < 30 mL/min/1.73m² (calculated using Modified Schwartz formula to estimate glomerular filtration rate [GFR]), based on the serum creatinine concentration obtained at the screening visit)
• WBC count < 3000/mm³
• Platelet count < 100,000/mm³
• Serum potassium > 5.2 mEq/L
• Other protocol-defined inclusion/exclusion criteria may apply