title: Therapeutic perspectives in hypertension: novel means for renin-angiotensin-aldosterone system modulation and emerging device-based approaches.
abstract: The conventional antihypertensive therapies including renin-angiotensin-aldosterone system antagonists (converting enzyme inhibitors, receptor blockers, renin inhibitors, and mineralocorticoid receptor blockers), diuretics, β-blockers, and calcium channel blockers are variably successful in achieving the challenging target blood pressure values in hypertensive patients. Difficult to treat hypertension is still a commonly observed problem world-wide. A number of drugs are considered to be used as novel therapies for hypertension. Renalase supplementation, vasopeptidase inhibitors, endothelin antagonists, and especially aldosterone antagonists (aldosterone synthase inhibitors and novel selective mineralocorticoid receptor blockers) are considered an option in resistant hypertension. In addition, the aldosterone antagonists as well as (pro)renin receptor blockers or AT(2) receptor agonists might attenuate end-organ damage. This array of medications has now been complemented by a number of new approaches of non-pharmacological strategies including vaccination, genomic interference, controlled breathing, baroreflex activation, and probably most successfully renal denervation techniques. However, the progress on innovative therapies seems to be slow and the problem of resistant hypertension and proper blood pressure control appears to be still persisting. Therefore the regimens of currently available drugs are being fine-tuned, resulting in the establishment of several novel fixed-dose combinations including triple combinations with the aim to facilitate proper blood pressure control. It remains an exciting question which approach will confer the best blood pressure control and risk reduction in this tricky disease.
authors.affiliation: Center for Cardiovascular Research, Charité-University Medicine, Hessische Str 3-4, Berlin 10115, Germany. thomas.unger@charite.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Unger
authors.forename: Ludovit
authors.initials: L
authors.lastname: Paulis
authors.forename: Domenic A
authors.initials: DA
authors.lastname: Sica
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D019405:Cytochrome P-450 CYP11B2 / Q000037:antagonists & inhibitors; D004338:Drug Combinations; D065128:Endothelin Receptor Antagonists; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D015316:Genetic Therapy; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D008995:Monoamine Oxidase / Q000187:drug effects; D011311:Pressoreceptors / Q000502:physiology; D011480:Protease Inhibitors / Q000627:therapeutic use; D011956:Receptors, Cell Surface / Q000037:antagonists & inhibitors; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012138:Respiratory Therapy / Q000379:methods; D013562:Sympathectomy / Q000379:methods; D014612:Vaccines; D015013:Yoga; D000093342:Prorenin Receptor; D000092502:Renin Inhibitors
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D019405:Cytochrome P-450 CYP11B2; D004338:Drug Combinations; D065128:Endothelin Receptor Antagonists; D004791:Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D008995:Monoamine Oxidase; D011480:Protease Inhibitors; D011956:Receptors, Cell Surface; D014612:Vaccines; D000093342:Prorenin Receptor; D000092502:Renin Inhibitors; C521557:renalase