- Sleep apnea or hypopnea can be a cause of resistant hypertension. It can also be a risk factor for atrial fibrillation.
- A new antihypertensive agent is now available. It is a drug called Aliskiren. This is a direct renin inhibitor which, by blocking renin, reduces plasma renin activity and angiotensin levels. Unlike the ACE inhibitors and Angiotensin receptor blockers, this drug does not increase plasma renin activity because it does not stimulate the feedback loop towards Renin in the Renin-Angiotensin-Aldosterone cycle. It has been used in a dose of 150mg and 300mg per day. It reduces systolic and diastolic BP in all age groups and there are no dose adjustments necessary in hepatic and renal impairment. Also it does not have any important drug interactions.
- If we know a patient’s plasma renin activity, we can use that in choosing an antihypertensive.
- low renin - Thiazide diuretics, loop diuretics and spironolactone are the choice in
- average renin - Alpha blockers
- high renin - Aliskiren, beta blockers
- The updated UK NICE guidelines on management of hypertension were also mentioned. These state that, for uncomplicated hypertension:
1. initial choice:
below 55 y/o - ACE inhibitors or ARB .
above 55 y/o / black - Diuretics or calcium channel blockers
3. The second step 2-drug combination of ACE inhibitors/ ARB with CCB / Diuretics.
4. The third step 3-drug combination of ACE inhibitors/ARB plus CCB plus Diuretics.
5. The fourth step is to +++ the dose of diuretics or + alpha blockers or beta blockers.
- The “Fab Four” drugs in the management of stable angina are:
- Beta blockers.
- There is now evidence from the BEAUTIFUL trial that a persistent heart rate above 70 beats per minute increases the risk for cardiovascular events. There is a new drug called Ivabradine that acts on the f-current (f current for funny current) in the SA node and reduces the heart rate. Trials with this drug have shown that it reduces myocardial infarctions in those with angina.
Apr 22, 2009
Aliskiren - new kid on the block
grateful to medtutor for an insightful summary and update of National Heart Association Scientific Meeting 2009 (NHAM) held from 17th to 19th April 2009 at the Hilton Hotel, Jalan Sentral, Kuala Lumpur.
category duty: primum non nocere