Cardiovascular Drugs and Therapy

, Volume 25, Issue 1, pp 87–97

Rationale for Combining a Direct Renin Inhibitor with other Renin- Angiotensin System Blockers. Focus on Aliskiren and Combinations


DOI: 10.1007/s10557-010-6278-0

Cite this article as:
Siragy, H.M. Cardiovasc Drugs Ther (2011) 25: 87. doi:10.1007/s10557-010-6278-0


Inhibition of the renin-angiotensin system has been a highly successful therapeutic approach for the prevention of hypertension-related end organ damage. Angiotensin converting enzyme inhibitors and angiotensin II receptor blockers lower blood pressure and reduce morbidity and mortality in patients with cardiovascular and kidney disease. However, progression to end-stage disease remains common in these patient populations. A compensatory increase in plasma renin activity occurs with the use of either angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, thus causing increased levels of angiotensin II, which may limit the therapeutic effectiveness of these agents. The direct renin inhibitor, aliskiren, suppresses the renin-angiotensin system by inhibiting its first and rate-limiting step. This early inhibition reduces the production of all downstream components of the system. In this review, recent clinically relevant advances in the understanding of renin-angiotensin system biology are explored as a rationale for combining aliskiren with other blockers of the renin-angiotensin system. These combinations more fully inhibit the renin-angiotensin system, with the goal of providing additional therapeutic benefits in diseases associated with chronic activation of the renin-angiotensin system.

Key words

AliskirenAngiotensin receptor blockersCombination therapyAngiotensin converting enzyme

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Division of Endocrinology and Metabolism, Department of MedicineUniversity of Virginia Health SystemCharlottesvilleUSA
  2. 2.Department of MedicineUniversity of Virginia Health CenterCharlottesvilleUSA