Renin inhibitors: cardiovascular drugs of the future?

This review explores whether the therapeutic attractiveness of renin inhibitors compared with angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists, is sufficient to warrant continued interest in their development for the treatment of cardiovascular disease. Clinical and experimental data available to date indicate that patients with hypertension and congestive heart failure will benefit from renin inhibition. However, clinical experience is very limited, and extra benefits of renin inhibitors compared with the other blockers of the renin-angiotensin system (RAS) have yet to be demonstrated. Some experimental data in animals and humans point to a greater effect of acute renin inhibition on renal blood flow than other modes of interference with the RAS. Again, the clinical benefits of such an effect, and particularly after long-term treatment, in hypertension and renal disease need to be determined. In today's cost-conscious health setting, only new drugs that bring additional clinical benefits have a good chance of being commercially viable. It remains to be seen whether renin inhibitors will fulfill these criteria.