Sign In

9.11 : Antihypertensive Drugs: Direct Renin Inhibitors

The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys, resulting in augmented blood volume and pressure. Hypertension, or high blood pressure, is often managed with inhibitors targeting different stages of RAAS. Angiotensin II receptor blockers (ARBs) obstruct angiotensin II from binding to receptors, instigating vasodilation and blood pressure reduction. ACE inhibitors hinder the transformation of angiotensin I to angiotensin II, lessening vasoconstriction and fluid volume, thereby lowering blood pressure. However, these inhibitors cannot inhibit ACE-independent pathways mediated by enzymes such as chymase or cathepsin G, which can enable angiotensin II production and its effects. To completely inhibit angiotensin II production, the initial step must be blocked. Direct renin inhibitors, like aliskiren, achieve this by directly binding to renin and preventing the conversion of angiotensinogen to angiotensin I. As a result, angiotensin II production decreases, leading to decreased vasoconstriction and lower blood pressure. Reduced angiotensin II production also diminishes aldosterone secretion, decreasing renal sodium and water reabsorption and reducing blood volume and pressure. However, aliskiren has side effects such as headache, gastroesophageal reflux, dizziness, fatigue, allergic reactions, and angioedema.

Tags
Antihypertensive DrugsDirect Renin InhibitorsRenin angiotensin aldosterone SystemRAASAngiotensin IIAldosteroneBlood PressureVasoconstrictionACE InhibitorsAngiotensin II Receptor BlockersAliskirenSodium ReabsorptionHypertension ManagementSide Effects

From Chapter 9:

article

Now Playing

9.11 : Antihypertensive Drugs: Direct Renin Inhibitors

Cardiovascular Drugs: Antihypertensive Drugs

126 Views

article

9.1 : Cardiovascular Drugs: Classification based on Therapeutic Indications

Cardiovascular Drugs: Antihypertensive Drugs

886 Views

article

9.2 : Hypertension and Regulation of Blood Pressure

Cardiovascular Drugs: Antihypertensive Drugs

588 Views

article

9.3 : Antihypertensive Drugs: Action of Diuretics

Cardiovascular Drugs: Antihypertensive Drugs

183 Views

article

9.4 : Antihypertensive Drugs: Thiazide-Class Diuretics

Cardiovascular Drugs: Antihypertensive Drugs

205 Views

article

9.5 : Antihypertensive Drugs: Potassium-Sparing Diuretics

Cardiovascular Drugs: Antihypertensive Drugs

195 Views

article

9.6 : Antihypertensive Drugs: Action of &#946;<sub>1</sub> Blockers

Cardiovascular Drugs: Antihypertensive Drugs

94 Views

article

9.7 : Antihypertensive Drugs: Types of &#946;-Blockers

Cardiovascular Drugs: Antihypertensive Drugs

137 Views

article

9.8 : Antihypertensive Drugs: Action of Calcium Channel Blockers

Cardiovascular Drugs: Antihypertensive Drugs

100 Views

article

9.9 : Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors

Cardiovascular Drugs: Antihypertensive Drugs

109 Views

article

9.10 : Antihypertensive Drugs: Angiotensin II Receptor Blockers

Cardiovascular Drugs: Antihypertensive Drugs

259 Views

article

9.12 : Antihypertensive Drugs: Vasodilators

Cardiovascular Drugs: Antihypertensive Drugs

138 Views

JoVE Logo

Privacy

Terms of Use

Policies

Research

Education

ABOUT JoVE

Copyright © 2025 MyJoVE Corporation. All rights reserved