In
part 1, I introduced
aliskiren and discussed the
renin-
angiontensin-
aldosterone system. As I mentioned, there are innumerable medications already available that effect this system, leading to the question: what's so special about
aliskiren?

(Diagram reproduced under the
GNU Free Documentation License.)
Aliskiren is a direct
renin inhibitor. Currently, all other agents that inhibit the
renin-
angiotensin-
aldsterone system (like ACE
inhbitors and
angiotensin receptor blockers) increase the levels of
renin (through feedback mechanisms). This increased
renin can potentially reduce the effectiveness of
theese medications.
Aliskiren, in contrast, reduces the activity of
renin and has the potential to blunt the effects of the increased
renin levels caused by other agents.
For lowering blood pressure,
aliskiren is indicated as a single agent and in combination with other agents that affect the
renin-
angiontensin-
aldosterone system. The blood pressure reductions with the combination of
aliskiren and other medications, in some studies, are greater than the reductions with either agent alone.
In addition, medications that block the
renin-
angiotensin-
aldosterone system are particularly important in patients with kidney disease and heart failure. For patients with kidney disease and protein in the urine, medications like ACE inhibitors and
angiotensin receptor blockers have been shown to protect the kidneys and prevent or delay progression of kidney disease. For patients with heart failure, these medications can improve symptoms and reduce mortality.
Whether
aliskiren alone or added to other medications is effective and may provide additional protection is unknown.
Studies on aliskiren in patients with heart and kidney disease are ongoing.
For a full description of
aliskiren, including potential side effects, see
www.tekturna.com.