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Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

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Direct renin inhibition improves parasympathetic function in diabetes.

R E Maser¹, M J Lenhard, P Kolm

¹Department of Medical Laboratory Sciences, University of Delaware, Newark, DE 19716, USA. rmaser@udel.edu

Diabetes, Obesity & Metabolism

|July 28, 2012

Summary

Direct renin inhibition with aliskiren improved cardiovascular autonomic function in patients with diabetes. This study found enhanced parasympathetic function, measured by MCR and E/I ratio, after 6 weeks of aliskiren treatment.

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Published on: June 6, 2025

Area of Science:

Cardiovascular Medicine
Endocrinology
Pharmacology

Background:

The renin-angiotensin-aldosterone system (RAAS) and autonomic nervous system are key regulators of cardiovascular function.
Dysregulation of these systems is implicated in cardiovascular disease progression and end-organ damage.
Direct renin inhibition offers a targeted approach to block the RAAS.

Purpose of the Study:

To investigate the impact of direct renin inhibition on cardiovascular autonomic function.
To assess whether aliskiren, a direct renin inhibitor, modulates parasympathetic nervous system activity.
To evaluate changes in autonomic function parameters in individuals with diabetes.

Main Methods:

A 6-week, double-blind, placebo-controlled trial involving 60 individuals with diabetes.
Participants received either 300 mg of aliskiren or placebo daily.
Cardiovascular autonomic function was assessed using power spectral analysis and RR-variation (mean circular resultant [MCR], expiration/inspiration [E/I] ratio) to evaluate parasympathetic function.

Main Results:

Aliskiren treatment significantly reduced blood pressure and plasma renin activity compared to placebo.
A significant improvement in MCR and E/I ratio was observed in the aliskiren group, indicating enhanced parasympathetic function.
Baseline characteristics and biochemical parameters were similar between groups prior to intervention.

Conclusions:

Direct renin inhibition with aliskiren effectively enhances parasympathetic cardiovascular autonomic function.
Downregulation of the RAAS through direct renin inhibition may be a therapeutic strategy for improving autonomic balance.
These findings suggest a potential benefit of aliskiren in managing cardiovascular autonomic dysfunction in diabetic patients.