Antihypertensive Efficacy of the Direct Renin Inhibitor Aliskiren as Add-on Therapy in Patients with Poorly Controlled Hypertension

Abstract

Objective A direct renin inhibitor, aliskiren, has a longer stable antihypertensive effect compared with other renin-angiotensin-aldosterone system (RAAS) inhibitors. Methods This study was a 6-month, single-center, open trial conducted between December 2010 and November 2011 to assess the antihypertensive effect of adding aliskiren (300 mg) to the treatment of essential hypertension patients whose target blood pressure (BP) had not been achieved and to assess whether it was possible to reduce the amount of antihypertensive drugs used. Results The results showed an overall improvement in the target BP achievement rate of 60% for clinic BP and 52% for home BP measurements (75 cases total). The mean number of drugs before treatment with aliskiren was 3.28±1.52, whereas at the end of the six months the mean number of drugs prescribed other than aliskiren was 2.85±1.72 (p<0.0001). Moreover, no worsening of the renal function was observed in patients with diabetes or chronic kidney disease (CKD) who were being treated with other RAAS inhibitors in combination to aliskiren. Conclusion These results showed that when aliskiren was added to the treatment of poorly controlled hypertension, the BP achievement rate increased, and it was possible to reduce the amount of antihypertensive drugs used in combination with aliskiren. Moreover, as a result of careful monitoring of the renal function or decreasing the amounts of drugs used in combination, no worsening of the renal function was observed even in the cases complicated by diabetes or CKD being treated with other RAAS inhibitors.

Aliskiren Reduces the Adrenal Zona Glomerulosa Apoptosis and Autophagy in Wistar Rats with 2K1C Hypertension

“…Aliskiren, the first effective direct oral renin inhibitor approved for the treatment of hypertension, acts by suppressing the first and rate-limiting step of the RAAS leading to more complete blockade of this system. Previous studies have demonstrated the potential for aliskiren in reducing plasma renin and angiotensin II activity and aldosterone levels, leading to lower blood pressure [ 4 , 29 ]. Additionally, this antihypertensive reduces remodeling, inflammation, stress-oxidation, and fibrosis in different tissues [ 27 , 30 ].…”

Aliskiren – an antihypertensive renin inhibitor in the treatment of patients with chronic kidney disease

“…Woo et al [33], based on their retrospective analysis, suggested that the findings of the ALTITUDE study would also apply to non-diabetic CKD patients. Patients with chronic glomerulonephritis (eGFR: 48-49 mL/min/1.73 m 2 ) subjected to combined aliskiren (150 mg/day) with losartan (100 mg/day) therapy, showed reduced proteinuria and BP as efficacious as aliskiren (150 mg/day) or losartan (200 mg/day) Tani et al 2016 aliskiren (300 mg) + existing antihypertensives hypertension in diabetic and non-diabetic nephropathy [39] Description and main results of the studies are provided in the text.…”

“…The authors concluded that the add-on therapy of aliskiren to ARB is not beneficial in these patients [38]. In 2016, Tani et al [39] reported that aliskiren (300 mg daily) is effective as add-on therapy in patients with poorly controlled hypertension, including patients with CKD. Furthermore, they suggested that by carefully monitoring the renal function and making adjustments to the drugs used, aliskiren can be safely used even in patients receiving other RAAS inhibitors to treat diabetes mellitus or CKD.…”