Renin inhibition: what are the clinical perspectives?

Evidence that renin system blockade is useful in many patients with hypertension is overwhelming. Two recent lines of investigation have suggested that more complete blockade leads to improved clinical outcomes. One line of investigation involves the use of a combination of an angiotensin-converting enzyme inhibitor with an angiotensin-receptor blocker. The second line of investigation involves the use of very high dose angiotensin-receptor blocker. The interaction of renin with substrate is the rate-limiting step in the renin cascade; thus, the recent development of a powerful renin inhibitor also favors more complete blockade of the system. In many patients, this is likely to lead to improved treatment.