Direct renin inhibitor launched as antihypertensive
Aliskiren: launched as antihypertensive and shows promise in heart
failure |
How Aliskiren works
Aliskiren is the first direct renin inhibitor to become available
in the UK and is licensed either as monotherapy or in combination
with other antihypertensives, although cardiologists expect
it to be used mostly in combination.
Aliskiren directly inhibits renin, which converts angiotensinogen
to angiotensin-I. Angiotensin-I is then converted to angiotensin-II
(ACE inhibitors block this step), triggering vasoconstriction (ARBs
stop angiotensin-II receptor binding).
|
Aliskiren (Rasilez), the first in a new class of antihypertensives, was launched
in the UK by Novartis this week.
Data presented at the European
Society of Cardiology meeting in Vienna
reveals that the drug produces further drops in blood pressure that are
sustained over 24 hours when added to existing treatment regimens. Another
study has suggested it holds promise as a new treatment for heart failure.
The hypertension study presented at the ESC meeting showed that aliskiren
provided consistent reductions in blood pressure sustained over 24 hours.
A
study published earlier this year in The Lancet suggested it
could add a further 4-5mmHg reduction in systolic blood pressure when
added
to a high dose angiotensin receptor blocker (ARB) or the angiotensin-converting
enzyme (ACE) inhibitor ramipril.
In the heart failure study, 302 patients with heart failure and current
or prior hypertension plus elevated B-type natriuretic peptide (BNP)
levels were randomised to receive aliskiren or placebo. Patients were
already treated with an ACE inhibitor or ARB and a beta-blocker unless
contraindicated or not tolerated. The investigators reported that aliskiren
reduced plasma BNP by five times more than placebo (-61pg/ml versus
-12pg/ml, P=0.016).
There was also an improvement in left ventricular
filling pressure as measured by Doppler-echocardiography. Aliskiren was
well tolerated and there was no significant excess of hypotension or
renal dysfunction, they added.
John McMurray, head of the British Heart Foundation Cardiovascular Research
Centre at the University of Glasgow, said: “The question now is
whether this could improve cardiac outcomes in this group of patients
but I think the data are promising and mean we should now start to plan
a phase III study.
“But we will have to work out whether aliskiren should be added to, or
used instead of, an ACE inhibitor.” |
The
Pharmaceutical Journal
Acrobat
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