Renin-angiotensin-aldosterone system blockade in high-risk hypertensive patients: Current approaches and future trends

Therapeutic Advances in Cardiovascular Disease

Volumn 4, Issue 6, 2010, Pages 359-373

  Gullapalli, Nageshwara ^a   Bloch, Michael J ^b   Basile, Jan ^c  

^a UNIVERSITY OF NEVADA   (United States)

^b UNIVERSITY OF NEVADA SCHOOL OF MEDICINE   (United States)

^c RALPH H JOHNSON VA MEDICAL CENTER   (United States)

Author keywords

Aliskiren; Angiotensin receptor blocker; Angiotensin converting enzyme inhibitor; Combination therapy; Direct renin inhibition; High risk patients; Mineralocorticoid receptor antagonists; Renin angiotensin aldosterone system blockade

Indexed keywords

ALISKIREN; AMLODIPINE; ANGIOTENSIN RECEPTOR ANTAGONIST; ANTIHYPERTENSIVE AGENT; ATENOLOL; CANDESARTAN; CAPTOPRIL; CHLORTALIDONE; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; ENALAPRIL; EPLERENONE; EPROSARTAN; HYDROCHLOROTHIAZIDE; INDAPAMIDE; IRBESARTAN; LISINOPRIL; LOSARTAN; NITRENDIPINE; PERINDOPRIL; PLACEBO; RAMIPRIL; RENIN; RENIN INHIBITOR; TELMISARTAN; TRANDOLAPRIL; VALSARTAN;

CARDIOVASCULAR DISEASE; CLINICAL TRIAL; DRUG ACTIVITY; DRUG BIOAVAILABILITY; DRUG DOSE TITRATION; DRUG MECHANISM; DRUG SAFETY; DRUG TOLERABILITY; HIGH RISK PATIENT; HUMAN; HYPERKALEMIA; HYPERTENSION; HYPOTENSION; KIDNEY DISEASE; PLASMA RENIN ACTIVITY; PRIORITY JOURNAL; RENIN ANGIOTENSIN ALDOSTERONE SYSTEM; REVIEW; SYNCOPE; UNSPECIFIED SIDE EFFECT;

AMIDES; ANGIOTENSIN RECEPTOR ANTAGONISTS; ANGIOTENSIN-CONVERTING ENZYME INHIBITORS; ANIMALS; ANTIHYPERTENSIVE AGENTS; BIOLOGICAL AVAILABILITY; FUMARATES; HUMANS; HYPERTENSION; RECEPTORS, MINERALOCORTICOID; RENIN; RENIN-ANGIOTENSIN SYSTEM;

EID: 78649357273     PISSN: 17539447     EISSN: None     Source Type: Journal    
DOI: 10.1177/1753944710384430     Document Type: Review

References (59)

1. Acute Infarction Ramipril Efficacy (AIRE) Study Investigators (1993) Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 342: 821-828.
2. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group (2002) Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 288: 2981-2997.
3. Azizi, M., Webb, R., Nussberger, J. and Hollenberg, N.K. ( 2006) Renin inhibition with aliskiren: Where are we now, and where are we going? J Hypertens 24: 243-256.
4. Bakris, G.L., Ruilope, L., Locatelli, F., Ptaszynska, A., Pieske, B., de Champlain, J. et al. (2007) Treatment of microalbuminuria in hypertensive subjects with elevated cardiovascular risk: Results of the IMPROVE trial. Kidney Int 72: 879-885.
5. Basile, J. ( 2009) New therapeutic options in patients prone to hypertension: A focus on direct renin inhibition and aldosterone blockade. Am J Med Sci 337: 438-444.
6. Bezencon, O., Bur, D., Weller, T., Richard-Bildstein, S., Remen, L., Sifferlen, T. et al. (2009) Design and preparation of potent, nonpeptidic, bioavailable renin inhibitors. J Med Chem 52: 3689-3702.
7. Bomback, A.S., Kshirsagar, A.V., Amamoo, M.A. and Klemmer, P.J. ( 2008) Change in proteinuria after adding aldosterone blockers to ACE inhibitors or angiotensin receptor blockers in CKD: A systematic review. Am J Kidney Dis 51: 199-211.
8. Brewster, U.C., Setaro, J.F. and Perazella, M.A. ( 2003) The renin-angiotensin-aldosterone system: Cardiorenal effects and implications for renal and cardiovascular disease states. Am J Med Sci 326: 15-24.
9. Brown, M.J. ( 2008) Aliskiren. Circulation 118: 773-784.
10. Brunner, H.R., Laragh, J.H., Baer, L., Newton, M.A., Goodwin, F.T., Krakoff, L.R. et al. (1972) Essential hypertension: Renin and aldosterone, heart attack and stroke. N Engl J Med 286: 441-449.
11. Chobanian, A.V., Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo Jr, J.L. et al. (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA 289: 2560-2572.
12. Dickstein, K. and Kjekshus, J. ( 2002) Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: The OPTIMAAL randomised trial. Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan. Lancet 360: 752-760.
13. Duprez, D.A., Munger, M.A., Botha, J., Keefe, D.L. and Charney, A.N. ( 2009) Aliskiren for geriatric lowering of systolic hypertension: A randomized controlled trial. J Hum Hypertens [Epub ahead of print].
14. Editors of The Lancet (2009) Retraction- Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): A randomised controlled trial. Lancet 374: 1226.
15. Epstein, B.J., Smith, S.M. and Choksi, R. (2009) Recent changes in the landscape of combination RAS blockade. Expert Rev Cardiovasc Ther 7: 1373-1384.
16. Fox, K.M. ( 2003) Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: Randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 362: 782-788.
17. Fyhrquist, F. and Saijonmaa, O. ( 2008) Renin-angiotensin system revisited. J Intern Med 264: 224-236.
18. Granger, C.B., McMurray, J.J., Yusuf, S., Held, P., Michelson, E.L., Olofsson, B. et al. (2003) Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: The CHARM-Alternative trial. Lancet 362: 772-776.
19. Julius, S., Kjeldsen, S.E., Weber, M., Brunner, H.R., Ekman, S., Hansson, L. et al. (2004) Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: The VALUE randomised trial. Lancet 363: 2022-2031.
20. Juurlink, D.N., Mamdani, M.M., Lee, D.S., Kopp, A., Austin, P.C., Laupacis, A. et al. (2004) Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med 351: 543-551.
21. Kober, L., Torp-Pedersen, C., Carlsen, J.E., Bagger, H., Eliasen, P., Lyngborg, K. et al. (1995) A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group. N Engl J Med 333: 1670-1676.
22. Kunz, R., Friedrich, C., Wolbers, M. and Mann, J.F. ( 2008) Meta-analysis: Effect of monotherapy and combination therapy with inhibitors of the renin angiotensin system on proteinuria in renal disease. Ann Intern Med 148: 30-48.
23. Lee, H.Y. and Oh, B.H. ( 2009) Cardio-renal protection with aliskiren, a direct renin inhibitor, in the ASPIRE HIGHER program. Expert Rev Cardiovasc Ther 7: 251-257.
24. Levy, B.I. ( 2005) How to explain the differences between renin angiotensin system modulators. Am J Hypertens 18: 134S-141S.
25. Mann, J.F., Schmieder, R.E., McQueen, M., Dyal, L., Schumacher, H., Pogue, J. et al. (2008) Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): A multicentre, randomised, double-blind, controlled trial. Lancet 372: 547-553.
26. McMurray, J.J., Ostergren, J., Swedberg, K., Granger, C.B., Held, P., Michelson, E.L. et al. (2003) Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: The CHARM-Added trial. Lancet 362: 767-771.
27. McMurray, J.J., Pitt, B., Latini, R., Maggioni, A.P., Solomon, S.D., Keefe, D.L. et al. (2008) Effects of the oral direct renin inhibitor aliskiren in patients with symptomatic heart failure. Circ Heart Fail 1: 17-24.
28. Mogensen, C.E., Neldam, S., Tikkanen, I., Oren, S., Viskoper, R., Watts, R.W. et al. (2000) Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: The candesartan and lisinopril microalbuminuria (CALM) study. BMJ 321: 1440-1444.
29. Nakao, N., Yoshimura, A., Morita, H., Takada, M., Kayano, T. and Ideura, T. ( 2003) Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): A randomised controlled trial. Lancet 361: 117-124.
30. Neal, B., MacMahon, S. and Chapman, N. ( 2000) Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: Results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet 356: 1955-1964.
31. Nguyen, G. and Muller, D.N. (2010) The biology of the (pro)renin receptor. J Am Soc Nephrol 21: 18-23.
32. Novartis Pharmaceuticals Corporation (2010 ) Tekturna® (Aliskiren) Tablets, Oral [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corporation.
33. O'Brien, E., Barton, J., Nussberger, J., Mulcahy, D., Jensen, C., Dicker, P. et al. (2007) Aliskiren reduces blood pressure and suppresses plasma renin activity in combination with a thiazide diuretic, an angiotensin-converting enzyme inhibitor, or an angiotensin receptor blocker. Hypertension 49: 276-284.
34. Oparil, S., Yarows, S.A., Patel, S., Fang, H., Zhang, J. and Satlin, A. ( 2007) Efficacy and safety of combined use of aliskiren and valsartan in patients with hypertension: A randomised, double-blind trial. Lancet 370: 221-229.
35. Parving, H.H., Brenner, B.M., McMurray, J.J., de Zeeuw, D., Haffner, S.M., Solomon, S.D. et al. (2009) Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE): Rationale and study design. Nephrol Dial Transplant 24: 1663-1671.
36. Parving, H.H., Persson, F., Lewis, J.B., Lewis, E.J. and Hollenberg, N.K. ( 2008) Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med 358: 2433-2446.
37. Pfeffer, M.A., McMurray, J.J., Velazquez, E.J., Rouleau, J.L., Kober, L., Maggioni, A.P. et al. (2003) Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 349: 1893-1906.
38. Phillips, C.O., Kashani, A., Ko, D.K., Francis, G. and Krumholz, H.M. ( 2007) Adverse effects of combination angiotensin II receptor blockers plus angiotensin-converting enzyme inhibitors for left ventricular dysfunction: A quantitative review of data from randomized clinical trials. Arch Intern Med 167: 1930-1936.
39. Pitt, B., White, H., Nicolau, J., Martinez, F., Gheorghiade, M., Aschermann, M. et al. (2005) Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure. J Am Coll Cardiol 46: 425-431.
40. Pitt, B., Zannad, F., Remme, W.J., Cody, R., Castaigne, A., Perez, A. et al. (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 341: 709-717.
41. Pool, J.L., Schmieder, R.E., Azizi, M., Aldigier, J.C., Januszewicz, A., Zidek, W. et al. (2007) Aliskiren, an orally effective renin inhibitor, provides antihypertensive efficacy alone and in combination with valsartan. Am J Hypertens 20: 11-20.
42. PROGRESS Collaborative Group (2001) Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 358: 1033-1041.
43. Rouleau, J.L., Packer, M., Moye, L., de Champlain, J., Bichet, D., Klein, M. et al. (1994) Prognostic value of neurohumoral activation in patients with an acute myocardial infarction: Effect of captopril. J Am Coll Cardiol 24: 583-591.
44. Rutherford, J.D., Pfeffer, M.A., Moye, L.A., Davis, B.R., Flaker, G.C., Kowey, P.R. et al. (1994) Effects of captopril on ischemic events after myocardial infarction. Results of the Survival and Ventricular Enlargement trial. SAVE Investigators. Circulation 90: 1731-1738.
45. Sever, P.S., Gradman, A.H. and Azizi, M. (2009) Managing cardiovascular and renal risk: The potential of direct renin inhibition. J Renin Angiotensin Aldosterone Syst 10: 65-76.
46. Solomon, S. ( 2010) Effect of the direct renin inhibitor aliskiren on left ventricular remodeling following myocardial infarction with left ventricular dysfunction: ASPIRE. Late Breaker presentation at American College of Cardiology 59th Annual Scientific Sessions.
47. Solomon, S.D., Appelbaum, E., Manning, W.J., Verma, A., Berglund, T., Lukashevich, V. et al. (2009) Effect of the direct renin inhibitor aliskiren, the angiotensin receptor blocker losartan, or both on left ventricular mass in patients with hypertension and left ventricular hypertrophy. Circulation 119: 530-537.
48. Staessen, J.A., Li, Y. and Richart, T. ( 2006) Oral renin inhibitors. Lancet 368: 1449-1456.
49. Stanton, A. ( 2008) Now that we have a direct renin inhibitor, what should we do with it? Curr Hypertens Rep 10: 194-200.
50. Taylor, A.A., Anderson, D.R., Arora, V., Satlin, A. and Prescott, M.F. ( 2007) Renin system suppression with the oral direct renin inhibitor aliskiren administered alone or in combination: A pooled analysis of 1093 patients with hypertension. J Am Coll Cardiol 49(9 Suppl A): 370A, Abstract 1014-1170.
51. Turnbull, F. ( 2003) Effects of different blood-pressure-lowering regimens on major cardiovascular events: Results of prospectively-designed overviews of randomised trials. Lancet 362: 1527-1535.
52. Unger, T. and Li, J. ( 2004) The role of the renin-angiotensin-aldosterone system in heart failure. J Renin Angiotensin Aldosterone Syst 5(Suppl 1): S7-S10.
53. Uresin, Y., Taylor, A.A., Kilo, C., Tschöpe, D., Santonastaso, M., Ibram, G. et al. (2007) Efficacy and safety of the direct renin inhibitor aliskiren and ramipril alone or in combination in patients with diabetes and hypertension. J Renin Angiotensin Aldosterone Syst 8: 190-198.
54. Vergaro, G., Fontana, M., Poletti, R., Giannoni, A., Iervasi, A.L., Masi, L. et al. (2008) Plasma renin activity is an independent prognostic factor in chronic heart failure. Eur Heart J 29(Suppl 1): 393, Abstract 2493.
55. Vitae Pharmaceuticals (2009) Vitae initiates phase 1 trial of novel renin inhibitor. Available at http:// www.medicalnewstoday.com/articles/164813.php [accessed 18 June 2010].
56. Weir, M.R. ( 2007) Effects of renin-angiotensin system inhibition on end-organ protection: Can we do better? Clin Ther 29: 1803-1824.
57. Yarows, S.A., Oparil, S., Patel, S., Fang, H. and Zhang, J. ( 2008) Aliskiren and valsartan in stage 2 hypertension: Subgroup analysis of a randomized, double-blind study. Adv Ther 25: 1288-1302.
58. Yusuf, S., Teo, K., Anderson, C., Pogue, J., Dyal, L., Copland, I. et al. (2008 a) Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: A randomised controlled trial. Lancet 372: 1174-1183.
59. Yusuf, S., Teo, K.K., Pogue, J., Dyal, L., Copland, I., Schumacher, H. et al. (2008 b) Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 358: 1547-1559.