What is new in hypertension?
Authors:
M. Souček
Authors‘ workplace:
II. interní klinika MU a FN u sv. Anny v Brně
Published in:
Kardiol Rev Int Med 2009, 11(2): 71-74
Overview
Aliskiren represents a new antihypertensive agent with the proven efficacy in mild and moderate hypertension and with a very good tolerability profile. It is so far the only representative of the new class of antihypertensives – direct rennin inhibitors. Aliskiren is effective in monotherapy and its addition to a combination treatment secures further blood pressure reduction. Subsequent section of the paper focuses on antihypertensive treatment in patients with diabetes mellitus. The target values are < 130/80 mmHg. Antihypertensive treatment is appropriate in patients with high normal BP (130–139/85–89 mmHg). RAS blockade is preferred (ACE-I or AT1- blockers). Combination treatment is often needed. The last section discusses the HYVET study that researched the issue of hypertension treatment in patients over 80 years of age. The study provides very important evidence that hypertension treatment with indapamide that was in more than 70% of patients combined with perindopril, provides significant positive effect in very old patients with hypertension and leads to reduction in the risk of all‑cause mortality, reduction in fatal cerebrovascular events and reduction in the risk of heart failure.
Keywords:
antihypertensive treatment – aliskiren – diabetes mellitus – indapamide – combination treatment
Sources
1. Zhao Ch, Vaidyanathan S, Yeh CM et al. Aliskiren exhibits similar pharmacokinetics in healthy volunteers and patients with type 2 diabetes mellitus. Clin Pharmacokinet 2006; 45: 1125–1134.
2. Azizi M, Médard J, Bissery A et al. Pharmacologic demonstration of the synergistic effects of a combination of the renin inhibitor aliskiren and the AT1 receptor antagonist valsartan on the angiotenzin II – renin feedback interruption. J Am Soc Nephrol 2004; 15: 3126–3133.
3. Stanton A, Jensen C, Nussberger J et al. Blood pressure lowering in essential hypertension with an oral renin inhibitor, aliskiren. Hypertension 2003; 42: 1137–1143.
4. Gradman AH, Schmieder RE, Lins RL et al. Aliskiren, a Novel Orally Effective Renin Inhibitor, Provides Dose‑Dependent Antihypertensive Efficacy and Placebo-Like Tolerability in Hypertensive Patients. Circulation 2005; 111: 1012–1018.
5. Villamil A, Chrysant SG, Calhoun D et al. Renin inhibitor with aliskiren provides additive antihypertensive efficacy when used in combination with hydrochlothiazide. J Hypertens 2007; 25: 217–226.
6. Weir M, Bush C, Zhang J et al. Antihypertensive efficacy and safety of the oral renin inhibitor aliskiren in patients with hypertension: a pooled analysis. World congress of Cardiology 2006; September 2–6, 2006, Barcelona, Spain. Eur Heart J 2006; Abstract 1796.
7. Uresin Y, Tailor AA, Kilo C et al. Efficacy and safety of the direct renin inhibitor aliskiren and ramipril alone or in combination in patients with diabetes and hypertension. J Renin Angiotensin Aldosterone Syst 2007; 8: 190–198.
8. Oh BH, Mitchell J, Herron JR et al. Aliskiren, an oral renin inhibitor, provides dose‑dependent efficacy and sustained 24- hour blood pressure control in patients with hypertension. J Am Coll Cardiol 2007; 49: 1157–1163.
9. Oparil S, Yarows S, Patel S et al. Efficacy and safety of combined use of aliskiren and valsartan in patients with hypertension: a randomised, double-blind trial. Lancet 2007; 370: 221–229.
10. McMurray JV, Pitt B, Latini A et al. Effects of the oral direct renin inhibitor aliskiren in patients with symptomatic heart failure. Circulation: Heart Failure 2008; 1: 17–24.
11. Parving HH, Persson F, Lewis JB et al. AVOID Study Investigators. Aliskiren combined with losartan in type 2 diabetes and nephropathy. N Engl J Med 2008; 358: 2433–2446.
12. Solomon SD, Appelbaum E, Manning WJ et al. Effect of the direct renin inhibitor aliskiren, either alone or in combination with losartan, compared to losartan, on left ventricular mass in patients with hypertension and left ventricular hypertrophy: The aliskiren left ventricular assessment of hypertrophy (ALLAY) trial. Presented at the American College of Cardiology, 57th Annual Scientific Session, March 31st, 2008.
13. Hansson L, Zanchetti A, Carruthers SG et al. Effect of intensive blood-pressure lowering and low‑dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised Trial. HOT Study Group. Lancet 1998; 351: 1755–1762.
14. UK Prospektive Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br Med J 1998; 317: 703–713.
15. Patel A and ADVANCE Collaborative Group. MacMahon S, Chalmers J, Neal B et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients type 2 diabetes mellitus (the ADVANCE trial): a randomized controlled trial. Lancet 2007; 370: 829–840.
16. Dluhy RG, McMahon GT. Intensive Glycemic Control in the ACCORD and ADVANCE Trials. N Engl J Med 2008; 358: 2630–2633.
17. Beckett NS, Peters R, Fletcher AE et al. for the HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887–1898.
Labels
Paediatric cardiology Internal medicine Cardiac surgery CardiologyArticle was published in
Cardiology Review
2009 Issue 2
Most read in this issue
- Diagnosis and treatment mistakes in acute forms of ischaemic heart disease
- Immunosuppression treatment following heart transplantation
- Cardiometabolic risk is a threat for the 21st century cardiology
- Rehabilitation of patients with ischemic heart disease