New drugs for hypertension: what do they offer?
A new drug might make a positive contribution to existing therapies for hypertension by: 1) reducing blood pressure (BP) via a novel pharmacologic mechanism; 2) possessing pharmacologic or pharmacokinetic properties that make it superior to other members of its class; or 3) facilitating BP control in refractory patients. In this paper, we review four experimental agents that promise to advance therapeutics by one of these mechanisms. Aliskiren is the first in a new class of potent, orally effective renin inhibitors. Aliskiren produces dose-dependent BP reduction with few side effects and constitutes a novel pharmacologic approach to renin-angiotensin-aldosterone inhibition. Nebivolol is a third-generation, cardioselective beta-blocker that produces vasodilation and improves endothelial function via the l-arginine/nitric oxide pathway. Clevidipine is an ultra-short-acting, vascular-selective, dihydropyridine calcium antagonist that is being developed for intravenous use in acute hospitalized patients. Darusentan is an endothelin(A) selective endothelin receptor antagonist that is effective in achieving BP control in a significant percentage of patients who remain uncontrolled despite treatment with three or more antihypertensive drugs.
Gradman
Alan H
AH
Division of Cardiovascular Diseases, The Western Pennsylvania Hospital, 4800 Friendship Avenue, Suite 3411 N, Pittsburgh, PA 15224, USA. gradmanmd@aol.com
Vivas
Yoel
Y
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000577:Amides; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001578:Benzopyrans / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D015507:Drugs, Investigational / Q000627:therapeutic use*; D065130:Endothelin A Receptor Antagonists; D004983:Ethanolamines / Q000627:therapeutic use; D005650:Fumarates / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D000068577:Nebivolol; D010666:Phenylpropionates / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D016896:Treatment Outcome; D000092502:Renin Inhibitors
D000319:Adrenergic beta-Antagonists; D000577:Amides; D000959:Antihypertensive Agents; D001578:Benzopyrans; D002121:Calcium Channel Blockers; D015507:Drugs, Investigational; D065130:Endothelin A Receptor Antagonists; D004983:Ethanolamines; D005650:Fumarates; D000068577:Nebivolol; D010666:Phenylpropionates; D011725:Pyridines; D011743:Pyrimidines; D000092502:Renin Inhibitors; C118563:clevidipine; C107831:darusentan; C446481:aliskiren