Hypertension treatment update: focus on direct renin inhibition

To provide an educational update for the nurse practitioner (NP) on the care of patients with hypertension, particularly in high-risk populations. Barriers to reaching blood pressure goals are reviewed in the context of identifying and addressing the sequelae of uncontrolled hypertension. Available antihypertensive agents are reviewed, including a description of direct renin inhibition with aliskiren, the newest agent and antihypertensive class available. Treatment recommendations are discussed in light of recent clinical trial data demonstrating improved cardiovascular (CV) outcomes, including myocardial infarction, stroke, and death.

Clinical studies and state-of-the-art articles indexed on PubMed

Current hypertension guidelines provide detailed management strategies, particularly for patients at high risk for CV events. NPs may help improve CV outcomes through careful diagnosis, risk stratification, and disease management, including improved patient education of the benefits of rational and sustained management of hypertension.

Early diagnosis, evidence-based treatment, and ongoing disease management of hypertension can be expected to improve CV outcomes. Treatment initiation with combination therapy, preferably with single-pill combinations that incorporate an agent that modulates the renin-angiotensin-aldosterone system, provides an approach that is safe, effective, and well tolerated and which can be tailored to the needs of the individual patient.