Direct inhibition of renin as a cardiovascular pharmacotherapy: focus on aliskiren.
The important role of renin-angiotensin-aldosterone system blockade in the treatment of systemic hypertension, heart failure, diabetic kidney disease, and atherogenesis has been clearly established. The theoretical therapeutic advantages for inhibiting the detrimental effects of the renin-angiotensin system at its most upstream point have served as the impetus for the development of renin inhibitors. The advent of aliskiren, the first in a novel class of orally active, nonpeptide, highly specific, human renin inhibitors, provides a new modality in the armamentarium of renin-angiotensin system antagonists. Studies in marmosets and rats demonstrated that aliskiren reduced blood pressure in a dose-dependent manner and is highly efficacious in blocking plasma renin activity with parallel reductions in the levels of the other downstream constituents of the renin-angiotensin system. Clinical trials in hypertensive patients have confirmed these benefits with aliskiren whose blood pressure-lowering efficacy is similar to or better than those of standard therapeutic doses of enalapril, losartan, irbesartan, and hydrochlorothiazide. Aliskiren is well tolerated, with few reported adverse effects even at the highest doses tested. Given the established beneficial effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the treatment of cardiovascular and renovascular diseases, future studies may further elucidate a similar protective role for aliskiren both as a monotherapy and as part of a combination therapy.
Sepehrdad
Reza
R
Department of Internal Medicine, UC Davis Medical Center, Sacramento, California, USA.
Frishman
William H
WH
Stier
Charles T
CT
Sica
Domenic A
DA
D000450:Aldosterone / Q000097:blood; D000577:Amides / Q000009:adverse effects / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D000804:Angiotensin II / Q000097:blood / Q000502:physiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D001713:Biphenyl Compounds / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D005650:Fumarates / Q000009:adverse effects / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D000077405:Irbesartan; D007668:Kidney / Q000098:blood supply; D010879:Piperazines / Q000494:pharmacology / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D011945:Receptors, Angiotensin / Q000187:drug effects / Q000502:physiology; D012039:Regional Blood Flow; D012083:Renin / Q000502:physiology; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology; D013329:Structure-Activity Relationship; D013777:Tetrazoles / Q000494:pharmacology / Q000627:therapeutic use; D013844:Thiazoles / Q000494:pharmacology / Q000627:therapeutic use; D000092502:Renin Inhibitors
D000450:Aldosterone; D000577:Amides; D000804:Angiotensin II; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D005650:Fumarates; D000077405:Irbesartan; D010879:Piperazines; D011945:Receptors, Angiotensin; D012083:Renin; D013777:Tetrazoles; D013844:Thiazoles; D000092502:Renin Inhibitors; C446481:aliskiren; C076903:zankiren hydrochloride