© 2007 European Society of Cardiology
Neurohumoral effects of the new orally active renin inhibitor, aliskiren, in chronic heart failure
a Department of Cardiology, Western Infirmary Glasgow, United Kingdom
b Department of Cardiology, Royal Infirmary Glasgow, United Kingdom
c School of Biological and Biomedical Sciences, Caledonian University Glasgow, United Kingdom
d Department of Cardiology, Southern General Hospital Glasgow, United Kingdom
e University Department of Medicine, City Hospital Birmingham, United Kingdom
f Speedel Pharma AG Basel, Switzerland
g Department of Cardiology, Royal Brompton Hospital London, United Kingdom
* Corresponding author. Department of Cardiology, Western Infirmary, Glasgow, G12 8QQ, United Kingdom. Tel.: +44 141 330 3479; fax: +44 141 330 6955. E-mail address: j.mcmurray{at}bio.gla.ac.uk
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Abstract |
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Background: Suppression of the renin–angiotensin–aldosterone system (RAAS) is therapeutically valuable in chronic heart failure (CHF). RAAS inhibition can be achieved in a number of ways though an orally active renin inhibitor (RI) has never been studied before. We describe the neurohumoral effects of an RI.
Methods and results: 27 patients with NYHA class II or III CHF and an ejection fraction 
0.35, were randomised to placebo, the ACE inhibitor ramipril or the RI aliskiren for 1week after a 5–7day washout period following ACE inhibitor withdrawal. Thereafter, patients were treated with either ramipril (target dose 10mg qd) or aliskiren (target dose 300mg qd) for a further 5weeks. Plasma renin activity (PRA), angiotensin II, aldosterone and B-type natriuretic peptide (BNP) were measured at baseline (pre-randomisation), after one week and at two week intervals thereafter. The mean changes (%) at the end of the study (6weeks), compared with baseline, were: PRA 164.9 (SD 149)% ramipril, –60.1 (24)% aliskiren (between groups p value<0.0001); angiotensin II 39.7 (138)% ramipril, –51.4 (40)% aliskiren (p<0.05); aldosterone –0.94 (67)% ramipril, 4.74 (60)% aliskiren (p=n.s.); BNP-7.51 (38)% ramipril, –1.79 (43)% aliskiren (p=n.s.).
Conclusions: Aliskiren appeared to suppress the RAAS as effectively as ramipril in the short term. RIs may offer an alternative therapeutic approach to the blockade of the RAAS.
Key Words: Heart failure • Renin • Angiotensin • Natriuretic peptides
Received May 22, 2007; Revised June 27, 2007; Accepted September 11, 2007
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