الفهرس 
Circulating renin and proreninOnly 14 pages are availabe for public view
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Abstract
The present study suggested that aliskiren, a direct renin inhibitor (DRI), is used as an effective antihypertensive therapy both as monotherapy and in combination with more conventional blockers of the renin-angiotensin-aldosterone system (RAAS). Aliskiren monotherapy (75–300 mg/day) has a dose-dependent antihypertensive effect that is comparable to that seen with other major classes of antihypertensive drugs and is associated with less side effects. Comparator studies have shown that aliskiren is as effective as hydrochlorothiazide (HCTZ), the angiotensin receptor blockers (ARBs) irbesartan, losartan and valsartan, the calcium channel blocker amlodipine and the beta blocker atenolol and may be slightly more effective than angiotensin converting enzyme inhibitors (ACEIs) in lowering BP. Further reductions in BP are seen when aliskiren is combined with antihypertensive drugs including RAAS blockers. Preclinical studies have shown that aliskiren, like other RAAS inhibitors, has renoprotective effects in both diabetic and non diabetic models of chronic kidney disease. Renoprotective effects of aliskiren have also been demonstrated in double transgenic rats (dTGR) that express genes for both human renin and angiotensinogen. Experimental studies have shown that aliskiren has anti-inflammatory and antioxidant effects by mechanism other than antihypertensive action. Animal experiments and human studies have demonstrated that pharmacological blockade of the RAAS has beneficial effects on atherosclerosis that seem to be independent of BP lowering effect. Also aliskiren attenuates cardiac dysfunction in animal models. The effect of aliskiren treatment on cardiac remodeling, apoptosis and left ventricular function after experimental myocardial infarction indicates the cardio-protective effects of aliskiren. Combination treatment with aliskiren is an effective and well-tolerated therapeutic option for obese hypertensive patients who fail to achieve BP control with thiazide diuretic. The RAAS has been implicated in both the pathogenesis and the vascular complications of diabetes. DRI treatment could prevent diabetes and the components of the metabolic syndrome. On the other hand, DRI-ACEI combination provides an effective and safe therapeutic option for the hypertensive diabetic patient. Ongoing studies are testing whether the DRI aliskiren is effective in prevention or regression of various forms of target organ damage in humans. Critical questions regarding the effectiveness of aliskiren in blocking the effects of renin/prorenin at the site of the (pro)renin receptor remain to be answered.