Renal and cardio-protective effects of direct renin inhibition: a systematic literature review

Journal of Hypertension
Issue: Volume 27(12), December 2009, p 2321–2331
Copyright: © 2009 Lippincott Williams & Wilkins, Inc.
Publication Type: [Meta-analyses]

aDepartment of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
bGeorge Institute for International Health, University of Sydney, Sydney, Australia

Results: Fifty-two articles were included. Blood pressure reductions were generally insufficient using early generation DRIs. However, recent DRIs have greater blood pressure-lowering effects. Preclinical and clinical studies showed profound effects of DRIs on markers of renal function, including clear increases in renal plasma flow and reductions in albuminuria. These effects were observed either alone or in combination with other RAAS inhibitors and suggest potential large renal protective benefit. DRIs improved hemodynamic cardiovascular parameters, such as total peripheral resistance, arterial pressure and left ventricular mass index, to a similar extent as those observed with other RAAS inhibitors. Furthermore, addition of DRIs to optimal heart failure treatment resulted in further reductions in B-type natriuretic peptide.


Conclusions: Evidence from preclinical and clinical studies suggests that DRIs may have renal and cardiovascular effects beyond their ability to lower blood pressure. Results of ongoing hard outcome trials are awaited to definitively assess the renal and cardio-protective effects of these agents.