Management of Hypertension. Aliskerin - New Kid on the Block

The World Congress of Cardiology in Barcelona heard a paper presented by Dr M Weir from the Maryland School of Medicine, Baltimore, about a pooled analysis on the use of Aliskerin, concerning the management of hypertension. He and his team analysed data from about 8,000 patients with mild or moderate hypertension, and showed that aliskerin as monotherapy was effective in lowering BP irrespective of age or gender.

Aliskerin is the first in a group of drugs called the direct renin inhibitor, acting at the start of the Renin-Angiotensin-Aldoterone system, thereby blocking the hypertension inducing effects of the RAA system at the origin. There has been presentations on the efficacy of aliskerin earlier, in the annual scientific meeting of the American Hypertension Society, and more recently, at the annual scientific meeting of the Europeans Society of Hypertension. They all show uniformly good results. We have written about aliskerin earlier too.

What is unique about Dr Weir's findings was that the dose of aliskerin is still rather ampirical. Also that it can be combined with other classes of anti-hypertensives except ARBs. Somehow, when aliskerin was combined with valsartan, it was not as effective as aliskerin combined with norvasc. However, it was interesting to note that when aliskerin was combined with an ACE-I, it was effective and in fact lessen the side-effects of cough, commonly encountered with the use of ACE-I. Aliskerin has also proven to have a rather long duration of action, so much so that although aliskerin was discontinued for a week or more, the anti-hypertensive effects still continued till almost a month. Indeed interesting, as this long duration of action will certainly lower the awakening surge in BP often associated with with an increased incidence of stroke and heart attacks. We are also waiting more data to see if Aliskerin will have the cardio and renal protective effects, so often seen with ARBs. Certainly much more work needs to be done with this new group of drugs, but whatever, we know now of directrenin inhibition seems very good and promising.