S Lam¹, S Saxena², LO Macina³ and PE Lester⁴

¹Assistant Clinical Professor, Department of Clinical Pharmacy Practice, College of Pharmacy and Allied Health Professions, St. John’s University, Jamaica, NY and Clinical Specialist in Geriatric Pharmacy, Divisions of Geriatric Medicine and Pharmacy, Winthrop University Hospital, Mineola, NY. ²Division of Geriatric Medicine, Winthrop University Hospital, Mineola, NY. ³Assistant Professor of Clinical Medicine, Stony Brook University Medical Center, Stony Brook, NY and Fellowship Program Director, Winthrop University Hospital, Mineola NY. ⁴Assistant Professor of Clinical Medicine, Stony Brook University Medical Center, Stony Brook, NY and Associate Fellowship Program Director, Winthrop University Hospital, Mineola NY.

Abstract

Hypertension can lead to significant morbidity and mortality, and requires lifestyle modifications with or without drug therapy to achieve target blood pressure control. Various classes of anti-hypertensive medications are available to healthcare providers. Choice of medications is based not only on efficacy but also tolerability and cost. Aliskiren is the first drug of a new class of agents known as renin inhibitors. It is approved by the U.S. Food and Drug Administration (FDA) as monotherapy or combination therapy with other antihypertensive agents to optimize blood pressure control. Its efficacy in blood pressure reduction is superior to placebo and comparable to angiotensin receptor blockers, hydrochlorothiazide, angiotensin-converting-enzyme inhibitors and atenolol. It also offers additional blood pressure reduction when used in combination of other agents. Recently, a study demonstrated its efficacy and safety in the elderly, and a study suggested its renoprotective effects in patient who were already taking losartan. More clinical studies are awaited to assess its potential for cardiovascular disease risk reduction. This paper reviews the pharmacology, efficacy and safety of aliskiren for the treatment of hypertension.