[The role of direct inhibitors of renin]

Aliskiren is the first direct oral renin inhibitor approved for the treatment of hypertension. It acts by binding to the active site of renin and blocking its catalytic function, as a result preventing the formation of the angiotensin I and II. Used in monotherapy or in combination, this molecule proved its antihypertensive efficacy without showing, however, a clear superiority on the other antihypertensive drugs. Its benefit on cardiovascular morbidity and mortality and on target organ damage should be proved before aliskiren may be recommended as a first line therapy in essential hypertension. Data on cardiac insufficiency and diabetic nephropathy are preliminary.