Renin inhibitors: novel agents for renoprotection or a better angiotensin receptor blocker for blood pressure lowering?
OBJECTIVE
Direct renin inhibitors are the newest antihypertensive therapeutic class. The review describes their antihypertensive and antiproteinuric effects and possible renoprotective capabilities.


RESULTS
Clinical trials demonstrate direct renin inhibitors reduce systolic and diastolic blood pressure comparable with other commonly used antihypertensive drugs, including angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. They also reduce proteinuria and are renoprotective in experimental models of kidney disease. Direct renin inhibitors, when used with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, offer incremental blood pressure reduction far greater than that observed when an angiotensin-converting enzyme inhibitor and angiotensin receptor blocker are used together. This suggests that renin inhibitors possess a unique and distinct mechanism of action compared with the other two therapeutic classes.


CONCLUSIONS
Direct renin inhibitors, due to their antihypertensive and antiproteinuric effects, and the unique mechanism of action resulting in reduction in plasma renin activity and suppression of angiotensin II levels, may offer a unique opportunity to facilitate blood pressure reduction with both angiotensin-converting enzyme inhibitors and angiotensin receptor blockers as well as other commonly used therapeutic classes. More effective blood pressure and proteinuria reduction coupled with a unique means of suppressing the renin angiotensin system may offer improved opportunity for renoprotection.
Weir
Matthew R
MR
Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. mweir@medicine.umaryland.edu
D057911:Angiotensin Receptor Antagonists; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D004338:Drug Combinations; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D008954:Models, Biological; D011507:Proteinuria / Q000378:metabolism; D011945:Receptors, Angiotensin / Q000378:metabolism; D012083:Renin / Q000097:blood; D013997:Time Factors; D000092502:Renin Inhibitors
D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D004338:Drug Combinations; D011945:Receptors, Angiotensin; D012083:Renin; D000092502:Renin Inhibitors