Unmet needs in managing hypertension: potential role of direct renin inhibition

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Hypertension is a major global risk factor for cardiovascular and renal diseases.
• Current antihypertensive treatments are insufficient, with only one-third of Americans achieving target blood pressure (< 140/90 mm Hg).
• There is a need for safer, more effective treatments and improved adherence to guidelines.

Purpose of the Study:

• To review new developments in agents targeting the renin-angiotensin-aldosterone system (RAAS).
• To highlight the unique mechanism of direct renin inhibitors in reducing plasma renin activity.
• To discuss the potential cardiovascular and renoprotective benefits of direct renin inhibition.

Main Methods:

• Review of current literature on RAAS inhibitors.
• Focus on direct renin inhibitors, specifically aliskiren.
• Examination of clinical trial data regarding efficacy and tolerability.

Main Results:

• All current RAAS blockers increase plasma renin concentration, except direct renin inhibitors.
• Direct renin inhibitors uniquely diminish plasma renin activity.
• Aliskiren, a direct renin inhibitor, is effective and well-tolerated in hypertensive patients, alone or in combination therapy.

Conclusions:

• Direct renin inhibitors represent a novel therapeutic class for hypertension.
• The reduction in plasma renin activity may offer additional cardiovascular and renoprotective benefits.
• Ongoing trials will further elucidate the protective effects of direct renin inhibition against cardiovascular and renal events.