| Aliskiren versus ramipril in hypertension. | |
| | |
MedLine Citation:
|
PMID: 20418269 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Aliskiren is an orally active direct renin inhibitor which inhibits the synthesis of angiotensin I by linking to active renin on a deep cleft of its molecular structure, the site of hydrolysis of the Leu10-Val11 bond of angiotensinogen. At variance with angiotensin-converting enzyme (ACE) inhibitors, aliskiren eliminates the main substrate for the 'escape' phenomenon (synthesis of angiotensin II from angiotensin I through alternative enzymatic pathways). The possibility that the antihypertensive effect of aliskiren differs from that of ACE inhibitors needs to be proved in specifically designed clinical trials. Over the past 2 years, three studies have been published which directly compared aliskiren with ramipril, in patients with hypertension. We made a pooled analysis of these studies. In order to avoid interference with additional drugs, analysis was restricted to trial periods when the two drugs were given as monotherapy. In each individual study, systolic blood pressure (BP) was slightly lower with aliskiren. Overall, systolic BP was lower with aliskiren than with ramipril (weighted mean difference between the treatments 1.84 mmHg; fixed effect model; p < 0.0001; and 1.87 mmHg; random effect model; p = 0.0055). The standardized mean difference between the treatments was 2.58 (fixed effect model; p < 0.0001) and 2.92 (random effect model; p = 0.0017) in favor of aliskiren. Compared with ramipril, aliskiren may have induced a more complete 'upstream' inhibition of the renin-angiotensin-aldosterone system, with consequent greater suppression of angiotensin II. Another potential explanation may be the longer terminal elimination halflife of aliskiren (about 40 hours) compared with ramiprilat (13-17 hours). These data provide further evidence that aliskiren monotherapy provides a sustained BP reduction over the 24 hours. |
| | |
Authors:
|
Paolo Verdecchia; Fabio Angeli; Giovanni Mazzotta; Paola Martire; Marta Garofoli; Giorgio Gentile; Gianpaolo Reboldi |
Related Documents
:
|
1145199 - Reciprocation of renin dependency with sodium volume dependency in renal hypertension. 2665519 - Sustained increases in plasma epinephrine concentration do not modulate renin release. 6100599 - Enalapril (mk421) in the treatment of hypertension with renal artery stenosis. 572749 - Effects of prazosin on blood pressure and plasma renin activity during onset and withdr... 6340859 - Effect of captopril on blood pressure and on the renin-angiotensin-aldosterone system i... 764929 - Renin concentrations and effects of propranolol and spironolactone in patients with hyp... 4395909 - Depression of proximal tubular sodium reabsorption in the dog in response to renal beta... 3899359 - Characterisation of aorto-iliac arterial stenoses in terms of pressure and flow. 23560059 - Regional cardiac dysfunction and dyssynchrony in a murine model of afterload stress. |
Publication Detail:
|
Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Review Date: 2010-04-23 |
Journal Detail:
|
Title: Therapeutic advances in cardiovascular disease Volume: 4 ISSN: 1753-9455 ISO Abbreviation: Ther Adv Cardiovasc Dis Publication Date: 2010 Jun |
Date Detail:
|
Created Date: 2010-05-27 Completed Date: 2010-09-09 Revised Date: 2011-03-11 |
Medline Journal Info:
|
Nlm Unique ID: 101316343 Medline TA: Ther Adv Cardiovasc Dis Country: England |
Other Details:
|
Languages: eng Pagination: 193-200 Citation Subset: IM |
Affiliation:
|
Department of Cardiology, Clinical Research Unit 'Preventive Cardiology', Hospital Santa Maria della Misericordia, 06156 Perugia, Italy. verdec@tin.it |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aging Amides / pharmacokinetics, therapeutic use* Angiotensin II / antagonists & inhibitors Angiotensin-Converting Enzyme Inhibitors / pharmacokinetics, therapeutic use* Antihypertensive Agents / pharmacokinetics, therapeutic use* Blood Pressure / drug effects Diabetic Angiopathies / drug therapy Fumarates / pharmacokinetics, therapeutic use* Half-Life Humans Hypertension / drug therapy* Ramipril / analogs & derivatives, pharmacokinetics, therapeutic use* Renin-Angiotensin System / drug effects |
| Chemical | |
Reg. No./Substance:
|
0/Amides; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Fumarates; 0/aliskiren; 11128-99-7/Angiotensin II; 87269-97-4/ramiprilat; 87333-19-5/Ramipril |
| Comments/Corrections | |
Erratum In:
|
Ther Adv Cardiovasc Dis. 2010 Aug;4(4):277 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Protective effects of aliskiren in doxorubicin-induced acute cardiomyopathy in rats.
Next Document: Dronedarone: an emerging therapy for atrial fibrillation.