These assumptions have been supported by the observation that 3 months of aliskiren 150 mg once daily provided additional blood pressure lowering on top op of an ACEi, ARB, or diuretic [82], and it reduced PRA, urinary aldosterone, and BNP on top of ‘optimal’ therapy in stable HF patients in the ALOFT trial [83]. Furthermore, aliskiren reduced LV mass as much as Losartan, and the combination reduced LV mass slightly more, however not statistically significant in patients with hypertension and left ventricular hypertrophy [84]. Unfortunately, the ASPIRE study did not show any improvement in echocardiographic measurements in patients with left ventricular dysfunction after myocardial infarction when treated with aliskiren on top of beta-blockers and ACEi or ARB [85], neither did the ALOFT trial in stable HF patients. This may however be due to the short follow-up time.