Renin Inhibitors

Aliskiren is an orally active renin inhibitor that appears to suppress the RAAS to a similar degree as ACE-inhibitors.76 The Aliskiren Observation of Heart Failure Treatment (ALOFT) study evaluated aliskiren in addition to an ACE-inhibitor in patients with NYHA class II-IV HF. The primary endpoint was the change from baseline to 3 months in N-terminal prohormone brain natriuretic peptide (NT-proBNP). NT-proBNP was lower for patients randomized to aliskiren, whereas it was higher for patients randomized to placebo (P=0.01).77,78 Phase 3 trials to evaluate the effects of aliskiren on mortality and morbidity are ongoing.