title: Effect of direct renin inhibitor, aliskiren, on peripheral blood monocyte subsets and myocardial salvage in patients with primary acute myocardial infarction.
abstract: BACKGROUND
  It remains unclear whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II type 1 receptor blockers (ARBs) have fully delivered the expected reduction in cardiovascular diseases. We investigated the effects of adding the direct renin inhibitor (DRI), aliskiren, to an ACEI or an ARB on monocyte subsets and myocardial salvage in patients with primary acute myocardial infarction (AMI).
  
  
  RESULTS
  Twenty-one consecutive patients were treated with an ACEI or an ARB (non-DRI group), and another 21 consecutive patients received aliskiren combined with an ACEI or an ARB (DRI group). Two monocyte subsets (CD14(+)CD16(-) and CD14(+)CD16(+)) were measured by flow cytometry. The extent of myocardial salvage 7 days after AMI was evaluated by cardiac magnetic resonance imaging. Both plasma renin activity and aldosterone levels were significantly lower in the DRI group than in the non-DRI group. Peak levels of CD14(+)CD16(-) monocyte number and ratio were also significantly lower in the DRI group. The extent of myocardial salvage was significantly higher in the DRI group than in the non-DRI group (44.8 [41.2-53.1] vs. 36.0 [28.5-42.6], P=0.001).
  
  
  CONCLUSIONS
  A DRI combined with an ACEI or an ARB can better improve the extent of myocardial salvage after AMI than an ACEI or an ARB alone in association with the decrease in circulating CD14(+)CD16(-) monocytes.
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ozaki
authors.forename: Toshio
authors.initials: T
authors.lastname: Imanishi
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanimoto
authors.forename: Manabu
authors.initials: M
authors.lastname: Kashiwagi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Tsujioka
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Sougawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Orii
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Shiono
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shimamura
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Kenichi
authors.initials: K
authors.lastname: Komukai
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ino
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D000368:Aged; D000450:Aldosterone / Q000097:blood; D000577:Amides / Q000627:therapeutic use*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination; D005260:Female; D005434:Flow Cytometry; D005650:Fumarates / Q000627:therapeutic use*; D058851:GPI-Linked Proteins / Q000097:blood; D006801:Humans; D007564:Japan; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000187:drug effects* / Q000276:immunology; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D011446:Prospective Studies; D017452:Receptors, IgG / Q000097:blood; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects*; D013997:Time Factors; D016896:Treatment Outcome; D000092502:Renin Inhibitors
chemical_list: D000450:Aldosterone; D000577:Amides; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D015415:Biomarkers; D005650:Fumarates; D058851:GPI-Linked Proteins; D018950:Lipopolysaccharide Receptors; D017452:Receptors, IgG; D012083:Renin; D000092502:Renin Inhibitors; C428200:FCGR3B protein, human; C446481:aliskiren