Renin Inhibitors

Aliskiren is the first agent in the newest class of antihypertensive agents. While similar to ACE inhibitors and ARBs in that it acts within the RAAS, it is unique in that it directly blocks renin thereby reducing plasma renin activity (PRA), and subsequently angiotensin I and angiotensin II, with a resultant reduction in BP. This disruption of the negative feedback loop results in a compensatory increase in renin levels—the significance of which is not yet known. Aliskiren has been shown to be well tolerated and effective in reducing BP when used as monotherapy and in combination with hydro-chlorothiazide or valsartan for patients with mild to moderate HTN. However, long-term clinical trials evaluating efficacy and safety have yet to be completed, and thus the effects of aliskiren on morbidity and mortality are as of yet unknown. Because of aliskiren's role in the RAAS, recommendations and precautions for monitoring serum potassium and kidney function should be similar to those of ACE inhibitors and ARBs.

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