Direct Renin Inhibitors: A New Approach to Antihypertensive Drug Treatment

Hypertension remains a leading cause of morbidity and mortality, affecting more than 60 million persons in the United States. Although the past 5 decades have witnessed advances in the therapeutic modalities available to treat hypertension and a dramatic decrease in morbidity and mortality related to hypertension, adequate blood pressure control has still not been achieved in a large number of patients. Therapeutic options to manage hypertension include agents that block the sympathetic nervous system, vasodilators, agents to control plasma volume, and drugs that act at various points in the renin-angiotensin system (RAS). Inadequate control of hypertension may be due in part to incomplete blockade of the RAS pathway in some patients; targeting a point earlier in this cascade might possibly improve control. Direct renin inhibitors, a new class of antihypertensive drugs, block the RAS pathway at the point of activation. Inhibition of renin prevents the downstream production of the potent vasoconstrictor angiotensin II, which is responsible for increasing blood pressure. Recent clinical data with aliskiren, a new direct renin inhibitor, suggest favorable results in patients with hypertension and a possible new treatment option.