Hypertension Management and End Organ Protection: Focus on Aliskiren

Abstract

Abstract:The renin-angiotensin system (RAS) activity is a key factor in the pathophysiology and development of hypertension, atherosclerosis, heart failure, and renal disease. It is unclear whether angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) have fully delivered the expected reductions in cardiovascular risk. In fact, the optimized RAS suppression is diffi cult to achieve with these agents, partly because ACE inhibitors and ARBs both activate compensatory feedback mechanisms that result in renin release and increase plasma renin activity (PRA). Molecular modeling was used to develop aliskiren, a potent, low-molecular-weight, nonpeptide, direct renin inhibitor with suffi cient bioavailability to produce sustained suppression of PRA after oral administration. This report discusses the mechanisms of action of oral renin inhibitors and their pharmacokinetic properties. In addition, the report also evaluates the available data regarding the effects of the renin inhibitor aliskiren in the treatment of hypertension and related cardiovascular disorders.

Good News from Aliskiren?

“…In the present issue of the Journal, Imanishi and coworkers 1 provide an excellent status-of-the-art review on aliskiren, a novel orally active direct renin inhibitor, the first to successfully reach the market. Although the advent of a new class of drugs is always an interesting scientific occurrence, from a clinical standpoint one may wonder whether there is a place for a drug like aliskiren in the already prosperous cardiovascular armamentarium.…”