Aliskiren: A New Drug for an Old Problem

The renin-angiotensin-aldosterone system plays a key role in the development of hypertension-related target organ damage. Nonetheless, compensatory increases in plasma renin levels that lead to adjustments in angiotensin production and conversion limit the potential benefits of both angiotensin converting enzyme inhibitors and angiotensin receptor blockers. On the other hand, the ONTARGET trial reported that the combination of two renin-angiotensin system inhibitors was associated with more adverse events without an increase in benefit. Aliskiren is a novel direct renin inhibitor with promising results. In this manuscript the current evidence about aliskiren, alone or in combination, is analyzed.