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Renin inhibition: the holy grail of renin–angiotensin system blockade?

Journal of Human Hypertension volume 21, pages 766–769 (2007)Cite this article

In this issue of the Journal of Human Hypertension, Strasser et al.1 present the results of a comparison of the direct renin inhibitor, aliskiren 150–300 mg daily and lisinopril 20–40 mg daily in severe hypertension. The treatments were similarly well tolerated (the primary end point) although the short duration of therapy meant that angiotensin-converting enzyme (ACE) inhibitor-induced cough was probably underestimated. Blood pressure changes were also similar. This small study suggests that renin inhibition offers a novel approach to blockade of the renin angiotensin system (RAS) with clinical utility which may challenge that of full-dose ACE inhibition.

Inhibition of the RAS is an effective way to intervene in the progression of cardiovascular and renal disorders.2 The system can be initiated at various points, with consequent reduction in blood pressure. Beta-blockers attenuate the release of renin from the juxta-glomerular apparatus.3 ACE inhibitors interfere with the conversion of angiotensin I to angiotensin II and also the inactivation of bradykinin and substance P, accumulation of which peptides mediate the main side effects of these drugs, cough4 and angioedema.5 Angiotensin receptor blockers (ARBs) inhibit the interaction between angiotensin II and angiotensin AT1 receptors, which modulate all the potential adverse effects of this peptide.6 Renin inhibitors block the RAS at the very origin.7, 8 Although all these drug classes inhibit the RAS, actions on the various components of the system differ (Table 1).

Table 1 Differences between RAS blockers
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    G T McInnes

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McInnes, G. Renin inhibition: the holy grail of renin–angiotensin system blockade?. J Hum Hypertens 21, 766–769 (2007). https://doi.org/10.1038/sj.jhh.1002221

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