Aliskiren and valsartan combination therapy for the management of hypertension

• Published in: Vascular health and risk management Vol. 6; no. default; pp. 711 - 722
• Main Author: Epstein, Benjamin J
• Format: Journal Article
• Language: English
• Published: New Zealand Taylor & Francis Ltd 01.01.2010; Dove Press; Dove Medical Press
• Subjects: ACE inhibitors; aliskiren; Amides - administration & dosage; Amides - therapeutic use; Angiotensin II Type 1 Receptor Blockers - administration & dosage; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - administration & dosage; Antihypertensive Agents - therapeutic use; Blood Pressure - drug effects; Blood Pressure - physiology; Combination therapy; Diuretics; Drug Therapy, Combination; Fumarates - administration & dosage; Fumarates - therapeutic use; Humans; Hypertension; Hypertension - drug therapy; Hypertension - physiopathology; plasma renin activity; Renin-Angiotensin System - drug effects; renin-angiotensin-aldosterone system; Review; single-pill combination; Tetrazoles - administration & dosage; Tetrazoles - therapeutic use; Valine - administration & dosage; Valine - analogs & derivatives; Valine - therapeutic use; Valsartan; renin-angiotensin-aldosterone system; valsartan; plasma renin activity; single-pill combination; aliskiren; hypertension
• ISSN: 1178-2048; 1176-6344; 1178-2048
• DOI: 10.2147/vhrm.s8175

Combination therapy is necessary for most patients with hypertension, and agents that inhibit the renin-angiotensin-aldosterone system (RAAS) are mainstays in hypertension management, especially for patients at high cardiovascular and renal risk. Single blockade of the RAAS with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) confers some cardiorenal protection; however, these agents do not extinguish the RAAS as evidenced by a reactive increase in plasma renin activity (PRA), a cardiovascular risk marker, and incomplete cardiorenal protection. Dual blockade with an ACE inhibitor and an ARB offers no additional benefit in patients with hypertension and normal renal and left ventricular function. Indeed, PRA increases synergistically with dual blockade. Aliskiren, the first direct renin inhibitor (DRI) to become available has provided an opportunity to study the merit of DRI/ARB combination treatment. By blocking the first and rate-limiting step in the RAAS, aliskiren reduces PRA by at least 70% and buffers the compensatory increase in PRA observed with ACE inhibitors and ARBs. The combination of a DRI and an ARB or an ACE inhibitor is an effective approach for lowering blood pressure; available data indicate that such combinations favorably affect proteinuria, left ventricular mass index, and brain natriuretic peptide in patients with albuminuria, left ventricular hypertrophy, and heart failure, respectively. Ongoing outcome studies will clarify the role of aliskiren and aliskiren-based combination RAAS blockade in patients with hypertension and those at high cardiorenal risk.