Hypertension rebels voice doubts about ALISKIREN
New York, NY - Doubts about the effectiveness of the new renin inhibitor antihypertensive aliskiren (Tektura, Novartis) have been voiced in a somewhat controversial review article in the May 2007 issue of the American Journal of Hypertension [1].
The authors, Dr John Laragh (editor of the journal) and his wife and fellow hypertension researcher Dr Jean Sealey (New York Hospital/Cornell University Medical Center, New York), say that aliskiren is no more effective than current antihypertensives and suggest that its ability to lower blood pressure may be limited by reactive renin secretion, an effect that may actually increase blood pressure in certain patient groups.
In an interview with heartwire, Laragh said: "We don't have an urgent need for a new drug like this. It is not a breakthrough. It is a weak antihypertensive drug. It is no better than what we already have, and it will be much more expensive. In addition, aliskiren causes a greater reactive rise in renin production than any other antihypertensive, which could be dangerous for patients with the most highly reactive renin systems."
Laragh and Sealey are no strangers to controversy, having been at the center of a bitter row with the American Society of Hypertension (ASH), which resulted in the American Journal of Hypertension no longer being the official journal of ASH and the end of Laragh's and Sealey's involvement with ASH.
Showing posts with label Aliskiren. Show all posts
Showing posts with label Aliskiren. Show all posts
Thursday, May 17, 2007
Friday, May 11, 2007
Reviewers Question First In-Class Rennin Inhibitor for Hypertension
Abstract:
Aliskiren, the First Renin Inhibitor for Treating Hypertension: Reactive Renin Secretion May Limit Its Effectiveness
American Journal of Hypertension, Volume 20, Issue 5, May 2007, Pages 587-597
Jean E. Sealey and John H. Laragh Jean E. Sealey and John H. LaraghDepartment of Cardiothoracic Surgery, New York Presbyterian Hospital and Weill Medical College of Cornell University, New York, New York.
A review of six clinical trials of aliskiren involving >5,000 patients with mild to moderate hypertension indicated that this first of a new class of orally active antihypertensive drugs is no more effective than angiotensin-converting enzyme inhibitors (CEIs), angiotensin receptor blockers (ARBs), or diuretics for lowering blood pressure. The starting dose is 150 mg; 300 mg is usually more effective, but 600 mg is no better than 300 mg. Aliskiren in combination with a diuretic appeared to lower blood pressure more than an aliskiren-ARB combination, but still failed to control blood pressure (<140/90) in 50% of the patients. Although aliskiren suppresses plasma renin activity, it causes much greater reactive rises in plasma renin concentration than does any other antihypertensive class tested.
Because aliskiren, like CEIs and ARBs, only blocks 90% to 95% of plasma renin, the pressor consequences of its greater reactive increases in plasma renin concentration appear to offset its net ability to lower blood pressure, especially with higher doses.
Patients with hyperreactive renin systems (renovascular, advanced, and malignant hypertension) were excluded from all of the trials.
Until the possibility is eliminated of inducing increases in blood pressure with aliskiren in patients with highly reactive renin levels, it seems safe and simple to stick to the less expensive, equally effective and widely available generic CEI drugs for treating the renin factor in hypertension.
Aliskiren, the First Renin Inhibitor for Treating Hypertension: Reactive Renin Secretion May Limit Its Effectiveness
American Journal of Hypertension, Volume 20, Issue 5, May 2007, Pages 587-597
Jean E. Sealey and John H. Laragh Jean E. Sealey and John H. LaraghDepartment of Cardiothoracic Surgery, New York Presbyterian Hospital and Weill Medical College of Cornell University, New York, New York.
A review of six clinical trials of aliskiren involving >5,000 patients with mild to moderate hypertension indicated that this first of a new class of orally active antihypertensive drugs is no more effective than angiotensin-converting enzyme inhibitors (CEIs), angiotensin receptor blockers (ARBs), or diuretics for lowering blood pressure. The starting dose is 150 mg; 300 mg is usually more effective, but 600 mg is no better than 300 mg. Aliskiren in combination with a diuretic appeared to lower blood pressure more than an aliskiren-ARB combination, but still failed to control blood pressure (<140/90) in 50% of the patients. Although aliskiren suppresses plasma renin activity, it causes much greater reactive rises in plasma renin concentration than does any other antihypertensive class tested.
Because aliskiren, like CEIs and ARBs, only blocks 90% to 95% of plasma renin, the pressor consequences of its greater reactive increases in plasma renin concentration appear to offset its net ability to lower blood pressure, especially with higher doses.
Patients with hyperreactive renin systems (renovascular, advanced, and malignant hypertension) were excluded from all of the trials.
Until the possibility is eliminated of inducing increases in blood pressure with aliskiren in patients with highly reactive renin levels, it seems safe and simple to stick to the less expensive, equally effective and widely available generic CEI drugs for treating the renin factor in hypertension.
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