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Combination renin-angiotensin system blockade with the renin inhibitor aliskiren in hypertension.
J Renin Angiotensin Aldosterone Syst. 2009 Dec; 10(4):185-9.JR

Abstract

Combining an angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin II receptor blocker (ARB) lowers blood pressure (BP) by 4/3 mmHg compared to either agent alone, although this additive effect may be abolished with maximal monotherapy dosing. The recent ONTARGET study showed no reduction in primary outcomes when an ACE-I-ARB combination was compared to an ACE-I alone, despite 2.4/1.4 mmHg lower BP in the former group. In proteinuric chronic kidney disease, an ACE-I-ARB combination reduces proteinuria and disease progression more than monotherapy, but the ONTARGET study showed an increase in renal endpoints in the combined group. Aliskiren offers a novel approach to renin-angiotensin system (RAS) inhibition. As monotherapy in hypertension, aliskiren is of similar efficacy to thiazides, calcium channel blockers and ARBs. In combination with other RAS inhibitors at maximal dosage aliskiren has a small synergistic effect on BP (additional 4/2 mmHg reduction). Early data suggest a role for aliskiren in preventing end-organ damage but, considering the ONTARGET results with an ACE-I-ARB combination, outcome studies are needed before the use of aliskiren can be recommended in combination with other RAS inhibitors. As monotherapy, aliskiren should probably be reserved for use as an alternative to ACE-Is or ARBs, where these are ineffective or poorly tolerated.

Authors+Show Affiliations

Blood Pressure Unit, Department of Cardiac and Vascular Sciences, St. George's, University of London, London, UK.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19617273

Citation

Doulton, Timothy W R., and Graham A. MacGregor. "Combination Renin-angiotensin System Blockade With the Renin Inhibitor Aliskiren in Hypertension." Journal of the Renin-angiotensin-aldosterone System : JRAAS, vol. 10, no. 4, 2009, pp. 185-9.
Doulton TW, MacGregor GA. Combination renin-angiotensin system blockade with the renin inhibitor aliskiren in hypertension. J Renin Angiotensin Aldosterone Syst. 2009;10(4):185-9.
Doulton, T. W., & MacGregor, G. A. (2009). Combination renin-angiotensin system blockade with the renin inhibitor aliskiren in hypertension. Journal of the Renin-angiotensin-aldosterone System : JRAAS, 10(4), 185-9. https://doi.org/10.1177/1470320309342733
Doulton TW, MacGregor GA. Combination Renin-angiotensin System Blockade With the Renin Inhibitor Aliskiren in Hypertension. J Renin Angiotensin Aldosterone Syst. 2009;10(4):185-9. PubMed PMID: 19617273.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination renin-angiotensin system blockade with the renin inhibitor aliskiren in hypertension. AU - Doulton,Timothy W R, AU - MacGregor,Graham A, Y1 - 2009/07/17/ PY - 2009/7/21/entrez PY - 2009/7/21/pubmed PY - 2010/2/26/medline SP - 185 EP - 9 JF - Journal of the renin-angiotensin-aldosterone system : JRAAS JO - J Renin Angiotensin Aldosterone Syst VL - 10 IS - 4 N2 - Combining an angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin II receptor blocker (ARB) lowers blood pressure (BP) by 4/3 mmHg compared to either agent alone, although this additive effect may be abolished with maximal monotherapy dosing. The recent ONTARGET study showed no reduction in primary outcomes when an ACE-I-ARB combination was compared to an ACE-I alone, despite 2.4/1.4 mmHg lower BP in the former group. In proteinuric chronic kidney disease, an ACE-I-ARB combination reduces proteinuria and disease progression more than monotherapy, but the ONTARGET study showed an increase in renal endpoints in the combined group. Aliskiren offers a novel approach to renin-angiotensin system (RAS) inhibition. As monotherapy in hypertension, aliskiren is of similar efficacy to thiazides, calcium channel blockers and ARBs. In combination with other RAS inhibitors at maximal dosage aliskiren has a small synergistic effect on BP (additional 4/2 mmHg reduction). Early data suggest a role for aliskiren in preventing end-organ damage but, considering the ONTARGET results with an ACE-I-ARB combination, outcome studies are needed before the use of aliskiren can be recommended in combination with other RAS inhibitors. As monotherapy, aliskiren should probably be reserved for use as an alternative to ACE-Is or ARBs, where these are ineffective or poorly tolerated. SN - 1752-8976 UR - https://www.unboundmedicine.com/medline/citation/19617273/Combination_renin_angiotensin_system_blockade_with_the_renin_inhibitor_aliskiren_in_hypertension_ L2 - https://journals.sagepub.com/doi/10.1177/1470320309342733?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -