title: Hemodynamic and hormonal changes to dual renin-angiotensin system inhibition in experimental hypertension.
abstract: We examined the antihypertensive effects of valsartan, aliskiren, or both drugs combined on circulating, cardiac, and renal components of the renin-angiotensin system in congenic mRen2.Lewis hypertensive rats assigned to: vehicle (n=9), valsartan (via drinking water, 30 mg/kg per day; n=10), aliskiren (SC by osmotic mini-pumps, 50 mg/kg per day; n=10), or valsartan (30 mg/kg per day) combined with aliskiren (50 mg/kg per day; n=10). Arterial pressure and heart rate were measured by telemetry before and during 2 weeks of treatment; trunk blood, heart, urine, and kidneys were collected for measures of renin-angiotensin system components. Arterial pressure and left-ventricular weight/tibia length ratio were reduced by monotherapy of valsartan, aliskiren, and further reduced by the combination therapy. Urinary protein excretion was reduced by valsartan and further reduced by the combination. The increases in plasma angiotensin (Ang) II induced by valsartan were reversed by the treatment of aliskiren and partially suppressed by the combination. The decreases in plasma Ang-(1-7) induced by aliskiren recovered in the combination group. Kidney Ang-(1-12) was increased by the combination therapy whereas the increases in urinary creatinine mediated by valsartan were reversed by addition of aliskiren. The antihypertensive and antiproteinuric actions of the combined therapy were associated with marked worsening of renal parenchymal disease and increased peritubular fibrosis. The data show that despite improvements in the surrogate end points of blood pressure, ventricular mass, and proteinuria, dual blockade of Ang II receptors and renin activity is accompanied by worsening of renal parenchymal disease reflecting a renal homeostatic stress response attributable to loss of tubuloglomerular feedback by Ang II.
authors.affiliation: Division of Surgical Sciences, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA. nmoniwa@wakehealth.edu
authors.forename: Norihito
authors.initials: N
authors.lastname: Moniwa
authors.forename: Jasmina
authors.initials: J
authors.lastname: Varagic
authors.forename: Sarfaraz
authors.initials: S
authors.lastname: Ahmad
authors.forename: Jessica L
authors.initials: JL
authors.lastname: VonCannon
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Simington
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Leanne
authors.initials: L
authors.lastname: Groban
authors.forename: K Bridget
authors.initials: KB
authors.lastname: Brosnihan
authors.forename: Sayaka
authors.initials: S
authors.lastname: Nagata
authors.forename: Johji
authors.initials: J
authors.lastname: Kato
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitamura
authors.forename: R Ariel
authors.initials: RA
authors.lastname: Gomez
authors.forename: Maria L Sequeira
authors.initials: ML
authors.lastname: Lopez
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Ferrario
mesh_terms: D000577:Amides / Q000494:pharmacology* / Q000627:therapeutic use; D000804:Angiotensin II / Q000097:blood; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology* / Q000627:therapeutic use; D000818:Animals; D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D004359:Drug Therapy, Combination; D005650:Fumarates / Q000494:pharmacology* / Q000627:therapeutic use; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D007668:Kidney / Q000187:drug effects / Q000378:metabolism; D008297:Male; D051381:Rats; D012084:Renin-Angiotensin System / Q000187:drug effects* / Q000502:physiology; D013686:Telemetry; D013777:Tetrazoles / Q000494:pharmacology* / Q000627:therapeutic use; D014633:Valine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000068756:Valsartan; D000092502:Renin Inhibitors
chemical_list: D000577:Amides; D000804:Angiotensin II; D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D005650:Fumarates; D013777:Tetrazoles; D014633:Valine; D000068756:Valsartan; D000092502:Renin Inhibitors; C446481:aliskiren