| Combination renin-angiotensin system blockade with the renin inhibitor aliskiren in hypertension. | |
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MedLine Citation:
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PMID: 19617273 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Timothy W R Doulton; Graham A MacGregor |
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Publication Detail:
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Type: Journal Article Date: 2009-07-17 |
Journal Detail:
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Title: Journal of the renin-angiotensin-aldosterone system : JRAAS Volume: 10 ISSN: 1752-8976 ISO Abbreviation: J Renin Angiotensin Aldosterone Syst Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2009-12-22 Completed Date: 2010-02-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100971636 Medline TA: J Renin Angiotensin Aldosterone Syst Country: England |
Other Details:
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Languages: eng Pagination: 185-9 Citation Subset: IM |
Affiliation:
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Blood Pressure Unit, Department of Cardiac and Vascular Sciences, St. George's, University of London, London, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Amides
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therapeutic use* Angiotensin II Type 1 Receptor Blockers / therapeutic use Angiotensin-Converting Enzyme Inhibitors / therapeutic use Antihypertensive Agents / therapeutic use* Drug Therapy, Combination Fumarates / therapeutic use* Humans Hypertension / drug therapy* Renin / antagonists & inhibitors* Renin-Angiotensin System / drug effects |
| Chemical | |
Reg. No./Substance:
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0/Amides; 0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Fumarates; 0/aliskiren; EC 3.4.23.15/Renin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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