Renin inhibitors?


Category : Medical Rants

The other day a drug rep started to pitch the new renin inhibitor. I told her that I would wait to read information on my own.

This article raises some interesting questions – Reviewers Question First In-Class Rennin Inhibitor for Hypertension

Aliskiren, the first oral antihypertensive agent in the renin-inhibitor class, is no better at reducing blood pressure than older agents, and in some patients may actually increase blood pressure, claimed two reviewers.

A review of studies involving more than 5,000 patients indicated that aliskiren (Tekturna, Rasilez) was no more effective than angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, found Jean E. Sealey, D.Sc., and John H. Laragh, M.D., of Weill Cornell Medical College here.

“Aliskiren in combination with a diuretic appeared to lower blood pressure more than an aliskiren-angiotensin receptor blocker combination, but still failed to control blood pressure (<140/90) in 50% of the patients,” the reviewers wrote in the May issue of the American Journal of Hypertension.

Others disagree with them.

But a hypertension researcher who has used the agents in clinical trials said that many of the claims by Dr. Sealey and Dr. Laragh are not backed by the evidence at hand, nor are they supported by results of a large study scheduled for publication in the near future by another hypertension journal.

So what is a generalist to do? My general philosophy on new drugs is to wait for a year or so to see what the literature says. While I am often an early adopter of new technology, with drugs I tend to lag a bit.

This class may represent a major benefit … or it may not. We need to follow the literature and learn about this drug over time.

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Comments (9)

Looking at the package insert it looks like the drug only caused hyperkalemia in the presence of ARB/ACEi so perhaps renin inhibitors will have a roll in patients intolerant of ACEi/ARB due to hyperkalemia.


Why the rush? With bisoprolol, HCTZ, & lisinopril all $4 a month Walmart meds (even combined) and with good heart failure, stroke, MI, etc. data; Aliskiren is at best a 4th line med unless it comes with some pretty amazing studies. You can control most patient’s BP with those for $8 a month with 2 pills once a day. If that’s not enough, you can throw in some generic felodipine and still be less than 1 Rx for Aliskiren.

From the flip side, I’ve been on every other medication for hypertension and due to strong negative and/or allergic reactions
I was getting no improvements and huge side effects. It was the 5th in line med for me and beta blockers just make me get fatter. My Dr. was pulling his hair out.
So.. I’ve had a month of the Aliskiren and my blood pressure is finally in the normal range for the first time in 6 months. I’m worried very much about the cost because it is expensive but I’m hoping that it will improve with time and that I get more samples :-).

We had a drug rep visit us today and tell us that it was more effective because it stopped Renin (an earlier part in the HTN cascade) and consequently was more effective at lowering BP than ARBs or ACE-I’s. Hmmmm. Any thoughts?

One thing we all should remember is that there is no one drug that fits us all. I have been on Norvasc, and HCT, and Benicar HCT (which gave me kidney failure and full Erectile dysfunction even with Cialis). I am hoping that this will solve my blood pressure and ED problems. By the way my mother takes Norvasc and is fine.

Brandon Bingham – Any thoughts?

MedRants: The other day a drug rep started to pitch the new renin inhibitor. >>>>>>>>>>>Hold Up. Bring your own lunch and don’t waste your time. The reps bring fatty food anyway and you’ll just get chubby. Reps make your brain shrink. Certainly dont see any reps until you think you might prescribe the drug, like you say, in a few years.

Chlorthalidone Man….Why not tell the reps what you want. What’s your favorite place to get your info on new stuff? Medical Letter…?

my doctor prescribed aliskiren along with diovan 300mg l50 mga;iskiren because I have a debilitating itching.  I am always worried about a new and powerful drug because my body does not tolerate  high dosages.will these two drugs work together or will they not?  I am desperate for more info.  thanks., Does novartis make a blood pressure pill that does not cause itching?  If so,what is it?

[…] have been varied, but I still stand by my doubts over its usefulness. Other medbloggers have expressed their doubts as well. And I should state right now that I think Tekturna being on the market is a Good Thing™. I […]

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