ALTITUDE trial

All,

I'm sure we are well aware of the negative preliminary results causing the early stoppage of the ALTITUDE trial (re: aliskiren + ACE/ARB in Type 2 diabetic patients). My question for those who work the various hypertension / outpatient clinics, what has been the response that the doctors in your practice doing in light of this data?

It's obvious that if a patient satisfies all the inclusion criteria to ALTITUDE, we stop one of the offending agents (ie stop aliskiren), but what are the docs doing in the non-diabetic patients? While there is no direct evidence that it will do harm and if we extrapolate from the data, I think all patients should NOT be on combined aliskiren + ACE/ARB. The evidence / clinical experience weighs heavily in favour of the ACE or ARB.

I would like to hear your thoughts on the topic. Thanks.
- derrick
Hotel-Dieu Grace Hospital
Windsor, ON

PS I have undertaken the daunting task of going over patient records and identifying the patients on combined aliskiren + ACE/ARB. Of course, our computer system can find the data, however, our IT coordinator does not have the capacity of fine-tuning the search feature (and she will not grant me rights to do such searches ... sigh ...) So I was able to find those who are on aliskiren then manually search to see if they are on an ACE/ARB and diabetic. It has taken me several hours, but I have gone through what I can.