Role of aliskiren in blood pressure control and renoprotection

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Patients with chronic kidney disease (CKD) have a significantly increased risk of cardiovascular disease (CVD), a leading cause of mortality in this population.
• Hypertension and proteinuria are key contributors to CKD progression, potentially leading to end-stage renal disease (ESRD).
• These factors can be primary or secondary, often potentiating each other as kidney disease advances.

Purpose of the Study:

• To highlight the critical role of managing hypertension and proteinuria in slowing nephropathic progression.
• To discuss the benefits and limitations of renin-angiotensin system (RAS) inhibitors.
• To introduce direct renin inhibitors (DRIs) as a novel therapeutic class for CKD.

Main Methods:

• Review of existing literature on CKD, hypertension, proteinuria, and cardiovascular risk.
• Analysis of the mechanisms of action for ACE inhibitors, ARBs, and DRIs.
• Evaluation of the impact of targeting the renin-angiotensin system on renal and cardiovascular outcomes.

Main Results:

• Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) effectively reduce blood pressure and proteinuria.
• A limitation of ACEi/ARBs is the persistent elevation of plasma renin activity, which may contribute to cardiovascular damage.
• Aliskiren, a direct renin inhibitor, demonstrates potent antihypertensive and antiproteinuric effects, offering a new therapeutic avenue.

Conclusions:

• Controlling hypertension and proteinuria is crucial for managing nephropathies and reducing cardiovascular risk in CKD patients.
• While RAS inhibitors are beneficial, elevated renin activity remains a concern.
• Direct renin inhibitors represent a promising therapeutic strategy, alone or in combination, to delay the progression of kidney disease and associated cardiovascular complications.