title: Aliskiren penetrates adipose and skeletal muscle tissue and reduces renin-angiotensin system activity in obese hypertensive patients.
abstract: OBJECTIVE
  In animals, the direct renin inhibitor aliskiren showed extensive tissue binding in the kidney and long-lasting renal effects. Aliskiren provides prolonged blood pressure-lowering effects following treatment discontinuation in patients. Therefore, we investigated whether aliskiren attains tissue concentrations sufficient to inhibit local renin-angiotensin system (RAS) activity in patients.
  
  
  METHODS
  We included 10 hypertensive patients with abdominal adiposity in an open-label study. Following 1-2 weeks washout, patients received 2 weeks placebo, then 4 weeks aliskiren 300 mg once daily, followed by 4 weeks washout, and then 4 weeks amlodipine 5 mg once daily. Drug concentrations and RAS biomarkers were measured in interstitial fluid using microdialysis and in biopsies from abdominal subcutaneous adipose and skeletal muscle.
  
  
  RESULTS
  We detected aliskiren in all compartments. After 4 weeks of treatment, microdialysate aliskiren concentrations (ng/ml) were 2.4 ± 2.1 (adipose) and 7.1 ± 4.2 (skeletal muscle), similar to plasma concentrations (8.4 ± 4.4); tissue concentrations (ng/g) were 29.0 ± 16.7 (adipose) and 107.3 ± 68.6 (skeletal muscle). Eight weeks after discontinuation, aliskiren was measurable in tissue biopsies but not in plasma or in interstitial fluid. Pooled microdialysate samples from two sets of four patients suggested reduction in tissue angiotensin II with aliskiren but not with amlodipine.
  
  
  CONCLUSIONS
  In obese hypertensive patients, aliskiren penetrates adipose and skeletal muscle tissue at levels that are apparently sufficient to reduce tissue RAS activity. Furthermore, tissue binding may contribute to aliskiren's prolonged blood pressure-lowering effect following discontinuation.
authors.affiliation: Franz Volhard Clinical Research Center, Charité, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Boschmann
authors.forename: Jürg
authors.initials: J
authors.lastname: Nussberger
authors.forename: Stefan
authors.initials: S
authors.lastname: Engeli
authors.forename: A H Jan
authors.initials: AH
authors.lastname: Danser
authors.forename: Ching-Ming
authors.initials: CM
authors.lastname: Yeh
authors.forename: Margaret F
authors.initials: MF
authors.lastname: Prescott
authors.forename: Marion
authors.initials: M
authors.lastname: Dahlke
authors.forename: Jens
authors.initials: J
authors.lastname: Jordan
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism*; D000328:Adult; D000577:Amides / Q000493:pharmacokinetics* / Q000627:therapeutic use; D017311:Amlodipine / Q000493:pharmacokinetics; D000959:Antihypertensive Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000493:pharmacokinetics; D045604:Extracellular Fluid / Q000378:metabolism; D005260:Female; D005650:Fumarates / Q000493:pharmacokinetics* / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000378:metabolism*; D009765:Obesity / Q000150:complications; D010865:Pilot Projects; D012084:Renin-Angiotensin System / Q000187:drug effects*
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D005650:Fumarates; D017311:Amlodipine; C446481:aliskiren