Department of Pharmacology, Istanbul Faculty of Medicine, Turgut Ozal Street 34390, Capa, Istanbul, Turkey.
Ther Adv Chronic Dis. 2013 Sep;4(5):232-41. doi: 10.1177/2040622313495288.
Aliskiren is the newest antihypertensive drug and the first orally active direct renin inhibitor to become available for clinical use. Clinical data have substantiated that the antihypertensive effectiveness of aliskiren is similar to that of the other major antihypertensive agents. Furthermore, aliskiren has a similar safety profile to placebo. Combination treatment with aliskiren showed significant blood pressure and proteinuria reductions compared with monotherapy. Aliskiren decreases plasma renin activity in contrast to other renin-angiotensin-aldosterone related drugs. The efficacy of aliskiren in treating major cardiovascular events and the prevention of end-organ damage are being investigated in the ASPIRE HIGHER program. Although the first studies of the ASPIRE HIGHER program such as ALOFT, AVOID, AGELESS showed favorable findings, ASPIRE and AVANT-GARDE studies provided contradictory results. Subsequently, the ALTITUDE study was terminated early because of safety issues and lack of beneficial effects. Most recently, the ASTRONAUT trial showed no reduction in cardiovascular death or heart failure rehospitalization with the addition of aliskiren to standard therapy in patients who were hospitalized for heart failure and with reduced left-ventricular ejection fraction. The results of ongoing studies in other patient groups such as the ATMOSPHERE trial are awaited.
阿利吉仑是最新的降压药，也是第一个可供临床使用的口服活性直接肾素抑制剂。临床数据证实，阿利吉仑的降压效果与其他主要降压药物相似。此外，阿利吉仑的安全性与安慰剂相似。与单药治疗相比，阿利吉仑联合治疗可显著降低血压和蛋白尿。与其他肾素-血管紧张素-醛固酮相关药物不同，阿利吉仑可降低血浆肾素活性。ASPIRE HIGHER 计划正在研究阿利吉仑在治疗主要心血管事件和预防终末器官损伤方面的疗效。尽管 ASPIRE HIGHER 计划的早期研究（如 ALOFT、AVOID、AGELESS）结果令人满意，但 ASPIRE 和 AVANT-GARDE 研究结果却相互矛盾。随后，由于安全性问题和缺乏有益效果，ALTITUDE 研究提前终止。最近，ASTRONAUT 试验显示，在因心力衰竭住院且左心室射血分数降低的患者中，加用阿利吉仑并不能降低心血管死亡或心力衰竭再住院的风险。正在其他患者群体（如 ATMOSPHERE 试验）中进行的研究的结果正在等待中。
