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class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>The renin–angiotensin–aldosterone system</span> </div> </a> <ul id="toc-The_renin–angiotensin–aldosterone_system-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Mechanism_of_action" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Mechanism_of_action"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Mechanism of action</span> </div> </a> <ul id="toc-Mechanism_of_action-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Drug_discovery_and_development" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Drug_discovery_and_development"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Drug discovery and development</span> </div> </a> <button aria-controls="toc-Drug_discovery_and_development-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Drug discovery and development subsection</span> </button> <ul id="toc-Drug_discovery_and_development-sublist" class="vector-toc-list"> <li id="toc-Pepstatin_–_the_first_renin_inhibitor" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pepstatin_–_the_first_renin_inhibitor"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Pepstatin – the first renin inhibitor</span> </div> </a> <ul id="toc-Pepstatin_–_the_first_renin_inhibitor-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-First_generation:_peptide_analogues" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#First_generation:_peptide_analogues"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>First generation: peptide analogues</span> </div> </a> <ul id="toc-First_generation:_peptide_analogues-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Second_generation:_peptide_mimetics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Second_generation:_peptide_mimetics"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Second generation: peptide mimetics</span> </div> </a> <ul id="toc-Second_generation:_peptide_mimetics-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Third_generation:_non-peptides" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Third_generation:_non-peptides"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.4</span> <span>Third generation: non-peptides</span> </div> </a> <ul id="toc-Third_generation:_non-peptides-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Binding_and_structure_activity_relationship_of_renin_inhibitors" class="vector-toc-list-item vector-toc-level-1 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<ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" 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class="mw-page-title-main">Renin inhibitor</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. 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interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Renininhibitor" title="Renininhibitor – German" lang="de" hreflang="de" data-title="Renininhibitor" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%85%D9%87%D8%A7%D8%B1%DA%A9%D9%86%D9%86%D8%AF%D9%87_%D8%B1%D9%86%DB%8C%D9%86" title="مهارکننده رنین – Persian" lang="fa" hreflang="fa" data-title="مهارکننده رنین" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Inibidor_da_renina" title="Inibidor da renina – Portuguese" lang="pt" hreflang="pt" data-title="Inibidor da renina" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A0%D0%B5%D0%BD%D0%B8%D0%BD%D0%BE%D0%B2%D1%8B%D0%B9_%D1%80%D0%B5%D1%86%D0%B5%D0%BF%D1%82%D0%BE%D1%80" title="Рениновый рецептор – Russian" lang="ru" hreflang="ru" data-title="Рениновый рецептор" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Zaviralec_renina" title="Zaviralec renina – Slovenian" lang="sl" hreflang="sl" data-title="Zaviralec renina" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/Reninski_inhibitor" title="Reninski inhibitor – Serbian" lang="sr" hreflang="sr" data-title="Reninski inhibitor" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Reninski_inhibitor" title="Reninski inhibitor – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Reninski inhibitor" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li> </ul> <div class="after-portlet after-portlet-lang"><span class="wb-langlinks-edit wb-langlinks-link"><a href="https://www.wikidata.org/wiki/Special:EntityPage/Q409255#sitelinks-wikipedia" title="Edit interlanguage links" class="wbc-editpage">Edit links</a></span></div> </div> </div> </div> </header> <div class="vector-page-toolbar"> <div class="vector-page-toolbar-container"> <div id="left-navigation"> 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.navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background-color: #ddbbee">Renin inhibitor</th></tr><tr><td colspan="2" class="infobox-subheader"><i><a href="/wiki/Drug_class" title="Drug class">Drug class</a></i></td></tr><tr><td colspan="2" class="infobox-image"><span class="mw-default-size skin-invert-image" typeof="mw:File/Frameless"><a href="/wiki/File:Aliskiren.svg" class="mw-file-description"><img alt="Aliskiren" src="//upload.wikimedia.org/wikipedia/commons/thumb/3/3d/Aliskiren.svg/280px-Aliskiren.svg.png" decoding="async" width="280" height="148" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/3d/Aliskiren.svg/420px-Aliskiren.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/3d/Aliskiren.svg/560px-Aliskiren.svg.png 2x" data-file-width="512" data-file-height="270" /></a></span><div class="infobox-caption"><a href="/wiki/Aliskiren" title="Aliskiren">Aliskiren</a>,<sup id="cite_ref-pmid15723979_1-0" class="reference"><a href="#cite_note-pmid15723979-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> the first renin inhibitor to be marketed</div></td></tr><tr><th colspan="2" class="infobox-header" style="background: #e8e8e8;">Class identifiers</th></tr><tr><th scope="row" class="infobox-label">Use</th><td class="infobox-data"><a href="/wiki/Hypertension" title="Hypertension">Hypertension</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Anatomical_Therapeutic_Chemical_Classification_System" title="Anatomical Therapeutic Chemical Classification System">ATC code</a></th><td class="infobox-data"><a href="/wiki/ATC_code_C09XA" class="mw-redirect" title="ATC code C09XA">C09XA</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Biological_target" title="Biological target">Biological target</a></th><td class="infobox-data"><a href="/wiki/Renin" title="Renin">Renin</a></td></tr><tr><th colspan="2" class="infobox-header" style="background: #e8e8e8;">Clinical data</th></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Drugs.com" title="Drugs.com">Drugs.com</a></th><td class="infobox-data"><span title="www.drugs.com"><a rel="nofollow" class="external text" href="https://www.drugs.com/drug-class/renin-inhibitors.html">Drug Classes</a></span></td></tr><tr><th colspan="2" class="infobox-header" style="background: #e8e8e8;">Legal status</th></tr><tr><td colspan="2" class="infobox-below" style="background: #e8e8e8; text-align: center"><a href="https://www.wikidata.org/wiki/Q409255" class="extiw" title="d:Q409255">In Wikidata</a></td></tr></tbody></table> <p><b>Renin inhibitors</b> are <a href="/wiki/Pharmaceutical_drugs" class="mw-redirect" title="Pharmaceutical drugs">pharmaceutical drugs</a> inhibiting the activity of <a href="/wiki/Renin" title="Renin">renin</a> that is responsible for hydrolyzing <a href="/wiki/Angiotensinogen" class="mw-redirect" title="Angiotensinogen">angiotensinogen</a> to <a href="/wiki/Angiotensin_I" class="mw-redirect" title="Angiotensin I">angiotensin I</a>,<sup id="cite_ref-CV_Pharmacology_2-0" class="reference"><a href="#cite_note-CV_Pharmacology-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Nakano_Everitt_2018_pp._75–86_3-0" class="reference"><a href="#cite_note-Nakano_Everitt_2018_pp._75–86-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-TeachMePhysiology_2020_4-0" class="reference"><a href="#cite_note-TeachMePhysiology_2020-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> which in turn reduces the formation of <a href="/wiki/Angiotensin_II" class="mw-redirect" title="Angiotensin II">angiotensin II</a> that facilitates <a href="/wiki/Blood_pressure" title="Blood pressure">blood pressure</a>.<sup id="cite_ref-Nussberger_2005_pp._754–764_5-0" class="reference"><a href="#cite_note-Nussberger_2005_pp._754–764-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Lambers_Heerspink_Fioretto_de_Zeeuw_2014_pp._222–234_6-0" class="reference"><a href="#cite_note-Lambers_Heerspink_Fioretto_de_Zeeuw_2014_pp._222–234-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>Renin inhibitor is often preceded by <i>direct</i>, called <b> <i>direct</i> renin inhibitor</b> in order to distinguish its mechanism from other <a href="/wiki/Renin%E2%80%93angiotensin%E2%80%93aldosterone_system" class="mw-redirect" title="Renin–angiotensin–aldosterone system">renin–angiotensin–aldosterone system</a>-interfering drugs such as <a href="/wiki/Angiotensin_converting_enzyme_inhibitor" class="mw-redirect" title="Angiotensin converting enzyme inhibitor">angiotensin converting enzyme inhibitors</a> (ACEIs), <a href="/wiki/Angiotensin_receptor_blocker" class="mw-redirect" title="Angiotensin receptor blocker">angiotensin receptor blockers</a> (ARBs) and <a href="/wiki/Aldosterone_receptor_antagonist" class="mw-redirect" title="Aldosterone receptor antagonist">aldosterone receptor antagonists</a>.<sup id="cite_ref-Lambers_Heerspink_Fioretto_de_Zeeuw_2014_pp._222–234_6-1" class="reference"><a href="#cite_note-Lambers_Heerspink_Fioretto_de_Zeeuw_2014_pp._222–234-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>These drugs <a href="/wiki/Enzyme_inhibitor" title="Enzyme inhibitor">inhibit</a> the first and <a href="/wiki/Rate-limiting_step" class="mw-redirect" title="Rate-limiting step">rate-limiting step</a> of the <a href="/wiki/Renin%E2%80%93angiotensin%E2%80%93aldosterone_system" class="mw-redirect" title="Renin–angiotensin–aldosterone system">renin–angiotensin–aldosterone system</a> (RAAS), namely the conversion of <a href="/wiki/Angiotensinogen" class="mw-redirect" title="Angiotensinogen">angiotensinogen</a> to <a href="/wiki/Angiotensin_I" class="mw-redirect" title="Angiotensin I">angiotensin I</a>. This leads to a totality in absence of <a href="/wiki/Angiotensin_II" class="mw-redirect" title="Angiotensin II">angiotensin II</a> based on the rationale that renin only acts to inhibit this step unlike Angiotensin Converting Enzyme which is also involved in other biochemical reactions. Since the 1970s, scientists have been trying to develop <a href="/wiki/Potency_(pharmacology)" title="Potency (pharmacology)">potent</a> inhibitors with acceptable oral <a href="/wiki/Bioavailability" title="Bioavailability">bioavailability</a>.<sup id="cite_ref-Jensen_7-0" class="reference"><a href="#cite_note-Jensen-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Gross_8-0" class="reference"><a href="#cite_note-Gross-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> The process was difficult and took about three decades. The first and second generations faced problems such as poor bioavailability and lack of potency. Finally, the third generation was discovered. These <a href="/wiki/Chemical_compound" title="Chemical compound">compounds</a> were non<a href="/wiki/Peptide" title="Peptide">peptidic</a> renin inhibitors, had acceptable oral bioavailability and were potent enough for clinical use. The first drug in this class was <a href="/wiki/Aliskiren" title="Aliskiren">aliskiren</a>, which received a marketing approval in 2007.<sup id="cite_ref-Jensen_7-1" class="reference"><a href="#cite_note-Jensen-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> As of June 2020<sup class="plainlinks noexcerpt noprint asof-tag update" style="display:none;"><a class="external text" href="https://en.wikipedia.org/w/index.php?title=Renin_inhibitor&action=edit">[update]</a></sup>, it is the only renin inhibitor on the market. </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=1" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In 1896, the Finnish physiologist <a href="/wiki/Robert_Tigerstedt" title="Robert Tigerstedt">Robert Tigerstedt</a> and the Swedish physician Per Bergman did an experiment on kidneys and the <a href="/wiki/Circulatory_system" title="Circulatory system">circulatory system</a> in rabbits. They observed that blood pressure rose in the rabbits when <a href="/wiki/Extract" title="Extract">extracts</a> of the kidneys were injected into their <a href="/wiki/Jugular_vein" title="Jugular vein">jugular veins</a>.<sup id="cite_ref-Ferrario_9-0" class="reference"><a href="#cite_note-Ferrario-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Phillips_10-0" class="reference"><a href="#cite_note-Phillips-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> They also discovered this substance responsible for higher blood pressure was produced in the <a href="/wiki/Renal_cortex" title="Renal cortex">renal cortex</a>, and they named it <a href="/wiki/Renin" title="Renin">renin</a>.<sup id="cite_ref-Phillips_10-1" class="reference"><a href="#cite_note-Phillips-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Although this experiment laid the foundation for future investigations into the RAAS pathway, it had little impact on the scientific community at that time.<sup id="cite_ref-Ferrario_9-1" class="reference"><a href="#cite_note-Ferrario-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Maibaum_11-0" class="reference"><a href="#cite_note-Maibaum-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> In 1934, when Goldblatt published his work in <a href="/wiki/Renal_ischaemia" class="mw-redirect" title="Renal ischaemia">renal ischaemia</a>, renin came into focus again. The importance of renin in the <a href="/wiki/Pathogenesis" title="Pathogenesis">pathogenesis</a> of <a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">cardiovascular disease</a> was, however, not fully understood until in the 1970s, and 20 years later the first renin inhibitors went to <a href="/wiki/Clinical_trial" title="Clinical trial">clinical trials</a>.<sup id="cite_ref-Jensen_7-2" class="reference"><a href="#cite_note-Jensen-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Pepstatin" title="Pepstatin">Pepstatin</a>, which was described in 1972, was the first synthetic renin inhibitor, but poor <a href="/wiki/Pharmacokinetic" class="mw-redirect" title="Pharmacokinetic">pharmacokinetic</a> properties prevented it from entering <i><a href="/wiki/In_vivo" title="In vivo">in vivo</a></i> investigations.<sup id="cite_ref-Gross_8-1" class="reference"><a href="#cite_note-Gross-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Wood_12-0" class="reference"><a href="#cite_note-Wood-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> The first generation of renin inhibitors, such as H-142, were peptide analogues of <a href="/wiki/Angiotensinogen" class="mw-redirect" title="Angiotensinogen">angiotensinogen</a>.<sup id="cite_ref-Szelke_13-0" class="reference"><a href="#cite_note-Szelke-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> However, these inhibitors had also limited drug-like properties.<sup id="cite_ref-Jensen_7-3" class="reference"><a href="#cite_note-Jensen-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Wood_12-1" class="reference"><a href="#cite_note-Wood-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Hopes of breakthrough appeared in 1982 when development of the second generation renin inhibitors began.<sup id="cite_ref-Jensen_7-4" class="reference"><a href="#cite_note-Jensen-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> This generation consisted of peptide-like compounds, such as <a href="/wiki/Remikiren" title="Remikiren">remikiren</a>, enalkiren and zanikiren.<sup id="cite_ref-Maibaum_11-1" class="reference"><a href="#cite_note-Maibaum-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> They had more drug-like rather than substrate-like properties, and in 1990 they went to clinical trials. The second generation had its limitations and never completed clinical trials.<sup id="cite_ref-Jensen_7-5" class="reference"><a href="#cite_note-Jensen-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>Aliskiren, the only renin inhibitor to go into phase III clinical trials, is not structurally related to peptides, which makes it a third-generation renin inhibitor.<sup id="cite_ref-Jensen_7-6" class="reference"><a href="#cite_note-Jensen-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Segall_14-0" class="reference"><a href="#cite_note-Segall-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> The first clinical trial was performed in 2000 in healthy volunteers.<sup id="cite_ref-Nussberger_15-0" class="reference"><a href="#cite_note-Nussberger-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> In 2007, aliskiren was approved by the <a href="/wiki/US_Food_and_Drug_Administration" class="mw-redirect" title="US Food and Drug Administration">US Food and Drug Administration</a> and the <a href="/wiki/European_Medicines_Agency" title="European Medicines Agency">European Medicines Agency</a> as a treatment for <a href="/wiki/Hypertension" title="Hypertension">hypertension</a>.<sup id="cite_ref-Jensen_7-7" class="reference"><a href="#cite_note-Jensen-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> A systematic review by the Cochrane Hypertension group found the maximum recommended dose of aliskiren produced an appreciable decline in blood pressure over placebo.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <figure class="mw-halign-center skin-invert-image" typeof="mw:File/Thumb"><a href="/wiki/File:Renin_inhibitor_timeline..png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f6/Renin_inhibitor_timeline..png/800px-Renin_inhibitor_timeline..png" decoding="async" width="800" height="286" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f6/Renin_inhibitor_timeline..png/1200px-Renin_inhibitor_timeline..png 1.5x, //upload.wikimedia.org/wikipedia/commons/f/f6/Renin_inhibitor_timeline..png 2x" data-file-width="1524" data-file-height="544" /></a><figcaption>Timeline: Discovery and development of renin inhibitors</figcaption></figure> <div class="mw-heading mw-heading2"><h2 id="The_renin–angiotensin–aldosterone_system"><span id="The_renin.E2.80.93angiotensin.E2.80.93aldosterone_system"></span>The renin–angiotensin–aldosterone system</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=2" title="Edit section: The renin–angiotensin–aldosterone system"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-halign-right skin-invert-image" typeof="mw:File/Thumb"><a href="/wiki/File:Renin-anigotensin_system_and_potential_steps_of_blockage..png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/41/Renin-anigotensin_system_and_potential_steps_of_blockage..png/500px-Renin-anigotensin_system_and_potential_steps_of_blockage..png" decoding="async" width="500" height="235" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/41/Renin-anigotensin_system_and_potential_steps_of_blockage..png/750px-Renin-anigotensin_system_and_potential_steps_of_blockage..png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/41/Renin-anigotensin_system_and_potential_steps_of_blockage..png/1000px-Renin-anigotensin_system_and_potential_steps_of_blockage..png 2x" data-file-width="1927" data-file-height="904" /></a><figcaption>Renin–angiotensin–aldosterone system and potential steps of blockage</figcaption></figure> <p>The <a href="/wiki/Renin%E2%80%93angiotensin%E2%80%93aldosterone_system" class="mw-redirect" title="Renin–angiotensin–aldosterone system">renin–angiotensin–aldosterone system</a> (RAAS) plays a key role in the <a href="/wiki/Pathology" title="Pathology">pathology</a> of <a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">cardiovascular disease</a>, <a href="/wiki/Hypertension" title="Hypertension">hypertension</a>, diabetic <a href="/wiki/Kidney_disease" title="Kidney disease">kidney disease</a> and <a href="/wiki/Heart_failure" title="Heart failure">heart failure</a>.<sup id="cite_ref-Weir_2007_17-0" class="reference"><a href="#cite_note-Weir_2007-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Under normal conditions, stimulation of the RAAS occurs in response to threats that compromise <a href="/wiki/Blood_pressure" title="Blood pressure">blood pressure</a> stability, such as <a href="/wiki/Hypotension" title="Hypotension">hypotension</a>, blood loss and excessive loss of sodium and water. Blood pressure depends on <a href="/wiki/Total_peripheral_resistance" class="mw-redirect" title="Total peripheral resistance">total peripheral resistance</a> and <a href="/wiki/Cardiac_output" title="Cardiac output">cardiac output</a>. </p><p>The highly <a href="/wiki/Functional_selectivity" title="Functional selectivity">selective</a> <a href="/wiki/Aspartic_protease" title="Aspartic protease">aspartic protease</a> renin is <a href="/wiki/Secretion" title="Secretion">secreted</a> from the <a href="/wiki/Juxtaglomerular_apparatus" title="Juxtaglomerular apparatus">juxtaglomerular apparatus</a>, which is the only source of active renin,<sup id="cite_ref-Castrop_2010_18-0" class="reference"><a href="#cite_note-Castrop_2010-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> although its precursor, <a href="/wiki/Prorenin" title="Prorenin">prorenin</a>, can be secreted by other <a href="/wiki/Tissue_(biology)" title="Tissue (biology)">tissues</a>, such as the salivary glands, brain, heart and blood vessels.<sup id="cite_ref-Castrop_2010_18-1" class="reference"><a href="#cite_note-Castrop_2010-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Tice_19-0" class="reference"><a href="#cite_note-Tice-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Ferrario2_20-0" class="reference"><a href="#cite_note-Ferrario2-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Renin is a circulating <a href="/wiki/Enzyme" title="Enzyme">enzyme</a> that acts on a circulating <a href="/wiki/Peptide" title="Peptide">peptide</a>, angiotensinogen.<sup id="cite_ref-Brown_21-0" class="reference"><a href="#cite_note-Brown-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Renin cleaves the peptide at the Leu10–Val11 bond, and this reaction is the <a href="/wiki/Rate-determining_step" title="Rate-determining step">rate-determining step</a> of the RAAS.<sup id="cite_ref-Rahuel_22-0" class="reference"><a href="#cite_note-Rahuel-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> This leads to the product <a href="/wiki/Angiotensin_I" class="mw-redirect" title="Angiotensin I">angiotensin I</a> (Ang I) which is a <a href="/wiki/Decapeptide" class="mw-redirect" title="Decapeptide">decapeptide</a>. Ang I is <a href="/wiki/Chemical_decomposition" title="Chemical decomposition">broken down</a> by the <a href="/wiki/Angiotensin-converting_enzyme" title="Angiotensin-converting enzyme">angiotensin-converting enzyme</a> (ACE) to the active octapeptide <a href="/wiki/Angiotensin_II" class="mw-redirect" title="Angiotensin II">angiotensin II</a> (Ang II), which is the principal effector of the RAAS.<sup id="cite_ref-Brown_21-1" class="reference"><a href="#cite_note-Brown-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Ang II stimulates renal sodium retention; promotes <a href="/wiki/Aldosterone" title="Aldosterone">aldosterone</a> secretion; causes <a href="/wiki/Vasoconstriction" title="Vasoconstriction">vasoconstriction</a>, and increases <a href="/wiki/Sympathetic_nervous_system" title="Sympathetic nervous system">sympathetic nervous system</a> activity.<sup id="cite_ref-Ferrario2_20-1" class="reference"><a href="#cite_note-Ferrario2-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Hsueh_23-0" class="reference"><a href="#cite_note-Hsueh-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Ang II also provides a <a href="/wiki/Negative_feedback" title="Negative feedback">negative feedback</a> to the system by inhibiting renin release by the juxtaglomerular apparatus.<sup id="cite_ref-Hsueh_23-1" class="reference"><a href="#cite_note-Hsueh-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Ang II interacts with at least two classes of <a href="/wiki/Angiotensin_receptor" class="mw-redirect" title="Angiotensin receptor">Ang II receptors</a>, <a href="/wiki/Angiotensin_II_receptor_type_1" title="Angiotensin II receptor type 1">AT1</a> and <a href="/wiki/Angiotensin_II_receptor_type_2" title="Angiotensin II receptor type 2">AT2</a>.<sup id="cite_ref-Ferrario2_20-2" class="reference"><a href="#cite_note-Ferrario2-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> This mechanism, which runs from renin through Ang II and to aldosterone, as well as the negative feedback that Ang II has on renin secretion, is known as RAAS.<sup id="cite_ref-Hsueh_23-2" class="reference"><a href="#cite_note-Hsueh-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> The net effect is to increase blood pressure, which in normal physiology is necessary in order to maintain <a href="/wiki/Homeostasis" title="Homeostasis">homeostasis</a>. </p><p>It is suspected that essential hypertension, a heterogeneous disorder whose long-term effects can be <a href="/wiki/End_organ_damage" title="End organ damage">end organ damage</a>, can involve at least in some cases an overactivity of this system, which several types of medications attempt to counter.<sup id="cite_ref-Brown_21-2" class="reference"><a href="#cite_note-Brown-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Renin <a href="/wiki/Concentration" title="Concentration">concentration</a> in <a href="/wiki/Blood_plasma" title="Blood plasma">blood plasma</a> tends to be higher in younger people with hypertension when vasoconstriction may be the main reason for high blood pressure. Conversely, renin is lower in older people or in people of African American or African Caribbean ethnicity when salt retention may contribute more to elevated blood pressure.<sup id="cite_ref-Brown_21-3" class="reference"><a href="#cite_note-Brown-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> However, the role of plasma renin levels in the etiology and management of hypertension is disputed.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Mechanism_of_action">Mechanism of action</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=3" title="Edit section: Mechanism of action"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Renin inhibitors bind to the <a href="/wiki/Active_site" title="Active site">active site</a> of renin and inhibit the binding of renin to angiotensinogen, which is the rate-determining step of the RAAS cascade.<sup id="cite_ref-Brown_21-4" class="reference"><a href="#cite_note-Brown-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Consequently, renin inhibitors prevent the formation of Ang I and Ang II. Renin inhibitors may also prevent Ang-(1-7), Ang-(1-9) and Ang-(1-5) formation,<sup id="cite_ref-Müller_25-0" class="reference"><a href="#cite_note-Müller-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> although it is not known if this is clinically important. Renin is highly selective for its only naturally occurring <a href="/wiki/Enzyme_substrate_(biology)" class="mw-redirect" title="Enzyme substrate (biology)">substrate</a> which is angiotensinogen, and the incidence of unwanted side effects with a renin inhibitor is infrequent.<sup id="cite_ref-Weir_26-0" class="reference"><a href="#cite_note-Weir-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> and similar to <a href="/wiki/Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">angiotensin II receptor antagonists</a>.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Ang II also functions within the RAAS as a negative feedback to suppress further release of renin. A reduction in Ang II levels or blockade of angiotensin receptors will suppress the feedback loop and lead to increased plasma renin concentrations (PRC) and <a href="/wiki/Plasma_renin_activity" title="Plasma renin activity">plasma renin activity</a> (PRA). This can be problematic for <a href="/wiki/ACE_inhibitor" title="ACE inhibitor">ACE inhibitor</a> and <a href="/wiki/Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">angiotensin II receptor antagonist</a> therapy since increased PRA could partially overcome the pharmacologic inhibition of the RAAS cascade. Because renin inhibitors directly affect renin activity, decrease of PRA despite the increased PRC (from loss of the negative feedback) may be clinically advantageous.<sup id="cite_ref-Staessen_28-0" class="reference"><a href="#cite_note-Staessen-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Drug_discovery_and_development">Drug discovery and development</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=4" title="Edit section: Drug discovery and development"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Pepstatin_–_the_first_renin_inhibitor"><span id="Pepstatin_.E2.80.93_the_first_renin_inhibitor"></span>Pepstatin – the first renin inhibitor</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=5" title="Edit section: Pepstatin – the first renin inhibitor"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Pepstatin" title="Pepstatin">Pepstatin</a> was the first <a href="/wiki/Chemical_synthesis" title="Chemical synthesis">synthetic</a> renin inhibitor. It is of <a href="/wiki/Microorganism" title="Microorganism">microbial</a> origin and is an N-acyl-pentapeptide, more accurately: isovaleryl-L-valyl-L-valyl-statyl-L-alanyl-statine.<sup id="cite_ref-Gross_8-2" class="reference"><a href="#cite_note-Gross-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Umezawa_29-0" class="reference"><a href="#cite_note-Umezawa-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> Pepstatin was found to be a potent <a href="/wiki/Competitive_inhibitor" class="mw-redirect" title="Competitive inhibitor">competitive inhibitor</a> of most aspartic proteases, but a weak inhibitor of renin.<sup id="cite_ref-Fisher_30-0" class="reference"><a href="#cite_note-Fisher-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Originally, it was thought to be effective in the treatment of <a href="/wiki/Duodenal" class="mw-redirect" title="Duodenal">duodenal</a> <a href="/wiki/Ulcer_(dermatology)" title="Ulcer (dermatology)">ulcers</a>, and went through clinical trials, but had no success.<sup id="cite_ref-Bonnevie_31-0" class="reference"><a href="#cite_note-Bonnevie-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Svendsen_32-0" class="reference"><a href="#cite_note-Svendsen-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Statine" title="Statine">Statine</a>, an <a href="/wiki/Amino_acid" title="Amino acid">amino acid</a>, is thought to be responsible for the inhibitory activity of pepstatin, because it mimics the tetrahedral <a href="/wiki/Transition_state" title="Transition state">transition state</a> of the peptide <a href="/wiki/Catalysis" title="Catalysis">catalysis</a>.<sup id="cite_ref-Marciniszyn_33-0" class="reference"><a href="#cite_note-Marciniszyn-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Because of <a href="/wiki/Hydrophobic" class="mw-redirect" title="Hydrophobic">hydrophobic</a> properties of statine, pepstatin has very low <a href="/wiki/Solubility" title="Solubility">solubility</a> in physiological media.<sup id="cite_ref-Eid_34-0" class="reference"><a href="#cite_note-Eid-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> Since it had low potency and poor solubility, it did not enter <i>in vivo</i> studies. </p> <div class="mw-heading mw-heading3"><h3 id="First_generation:_peptide_analogues">First generation: peptide analogues</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=6" title="Edit section: First generation: peptide analogues"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size skin-invert-image" typeof="mw:File/Thumb"><a href="/wiki/File:Skeletal_formula_of_H-142..png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/20/Skeletal_formula_of_H-142..png/220px-Skeletal_formula_of_H-142..png" decoding="async" width="220" height="84" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/20/Skeletal_formula_of_H-142..png/330px-Skeletal_formula_of_H-142..png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/20/Skeletal_formula_of_H-142..png/440px-Skeletal_formula_of_H-142..png 2x" data-file-width="2081" data-file-height="798" /></a><figcaption>H-142<sup class="noprint Inline-Template" style="margin-left:0.1em; white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Please_clarify" title="Wikipedia:Please clarify"><span title="The text near this tag may need clarification or removal of jargon. (October 2011)">clarification needed</span></a></i>]</sup></figcaption></figure> <p>This generation consists of two groups of compounds, either peptide analogues of the prosegment of renin<sup id="cite_ref-Cumin_35-0" class="reference"><a href="#cite_note-Cumin-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> or peptide analogues of the <a href="/wiki/N-terminus" title="N-terminus">amino-terminal part</a> of the substrate angiotensinogen.<sup id="cite_ref-Szelke_13-1" class="reference"><a href="#cite_note-Szelke-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Szelke2_36-0" class="reference"><a href="#cite_note-Szelke2-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Tree_37-0" class="reference"><a href="#cite_note-Tree-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> The drugs in the latter group seemed to be effective in inhibiting renin activity and lowering blood pressure in both animals and humans.<sup id="cite_ref-Webb_38-0" class="reference"><a href="#cite_note-Webb-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> Unfortunately, they had to be given <a href="/wiki/Parenterally" class="mw-redirect" title="Parenterally">parenterally</a> because of poor bioavailability. They also turned out to have short durations of action, low potencies and their ability to lower blood pressure was inadequate. None of these drugs completed clinical investigations.<sup id="cite_ref-Staessen_28-1" class="reference"><a href="#cite_note-Staessen-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Second_generation:_peptide_mimetics">Second generation: peptide mimetics</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=7" title="Edit section: Second generation: peptide mimetics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size skin-invert-image" typeof="mw:File/Thumb"><a href="/wiki/File:Remikiren.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/ce/Remikiren.png/220px-Remikiren.png" decoding="async" width="220" height="122" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/ce/Remikiren.png/330px-Remikiren.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/ce/Remikiren.png/440px-Remikiren.png 2x" data-file-width="1566" data-file-height="865" /></a><figcaption><a href="/wiki/Remikiren" title="Remikiren">Remikiren</a>, a second-generation renin inhibitor</figcaption></figure> <p>Compounds in this generation were more potent, more stable and had longer durations of action. One of these, <a href="/w/index.php?title=CGP2928&action=edit&redlink=1" class="new" title="CGP2928 (page does not exist)">CGP2928</a>, a <a href="/wiki/Peptidomimetic" title="Peptidomimetic">peptidomimetic</a> compound, was the first renin inhibitor proven effective when taken orally. Tested on <a href="/wiki/Marmoset" title="Marmoset">marmosets</a>, it was only active at high doses.<sup id="cite_ref-Wood_12-2" class="reference"><a href="#cite_note-Wood-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Development of new drugs in the second generation continued to improve pharmacokinetic properties. Remikiren, enalkiren and zankiren were then discovered. These were peptidomimetic inhibitors with improved structures that made them more specific, potent and stable. Unfortunately, clinical development was terminated because the drugs had poor oral bioavailability (poorly absorbed and rapidly metabolized) and lowering blood pressure activity still remained low.<sup id="cite_ref-Jensen_7-8" class="reference"><a href="#cite_note-Jensen-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Rahuel_22-1" class="reference"><a href="#cite_note-Rahuel-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Staessen_28-2" class="reference"><a href="#cite_note-Staessen-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Third_generation:_non-peptides">Third generation: non-peptides</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=8" title="Edit section: Third generation: non-peptides"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size skin-invert-image" typeof="mw:File/Thumb"><a href="/wiki/File:Aliskiren.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/3d/Aliskiren.svg/220px-Aliskiren.svg.png" decoding="async" width="220" height="116" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/3d/Aliskiren.svg/330px-Aliskiren.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/3d/Aliskiren.svg/440px-Aliskiren.svg.png 2x" data-file-width="512" data-file-height="270" /></a><figcaption><a href="/wiki/Aliskiren" title="Aliskiren">Aliskiren</a>, the third-generation renin inhibitor</figcaption></figure> <p><a href="/wiki/Aliskiren" title="Aliskiren">Aliskiren</a>, an orally active non-peptide renin inhibitor, was the first drug in its class on the market. It is used to treat hypertension as <a href="/wiki/Monotherapy" class="mw-redirect" title="Monotherapy">monotherapy</a> or in combination with other antihypertensive agents.<sup id="cite_ref-Jensen_7-9" class="reference"><a href="#cite_note-Jensen-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Riccioni_2013_pp._139–145_39-0" class="reference"><a href="#cite_note-Riccioni_2013_pp._139–145-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> The key to the discovery of aliskiren was <a href="/wiki/Crystallography" title="Crystallography">crystallography</a> and <a href="/wiki/Molecular_modeling" class="mw-redirect" title="Molecular modeling">molecular modeling</a> techniques. Now, a solution has been found to the problem that impeded the development of the renin inhibitors of the previous generations. Non-peptide substances were known to be able to solve the problems of poor pharmacokinetic properties and low specificity. This led to the design of small molecules, non-peptide inhibitors, which were very potent and specific of human renin.<sup id="cite_ref-Rahuel_22-2" class="reference"><a href="#cite_note-Rahuel-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Cohen_40-0" class="reference"><a href="#cite_note-Cohen-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p><p>However, caused by their chemical structure even third-generation renin inhibitors are difficult to resorb by the human body and their oral bioavailability is often below 2%. </p> <div class="mw-heading mw-heading2"><h2 id="Binding_and_structure_activity_relationship_of_renin_inhibitors">Binding and structure activity relationship of renin inhibitors</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=9" title="Edit section: Binding and structure activity relationship of renin inhibitors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The renin molecule is a monospecific enzyme that belongs to the aspartic protease family.<sup id="cite_ref-Winiecka_41-0" class="reference"><a href="#cite_note-Winiecka-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Its structure is complex and consists of two homologous lobes that fold mainly in a <a href="/wiki/Beta_sheet" title="Beta sheet">β-sheet</a> conformation.<sup id="cite_ref-Rahuel_22-3" class="reference"><a href="#cite_note-Rahuel-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Between the two lobes, deep within the enzyme, resides the <a href="/wiki/Active_site" title="Active site">active site</a>, and its catalytic activity is due to two <a href="/wiki/Aspartic_acid" title="Aspartic acid">aspartic acid</a> residues (Asp32 and Asp 215, one from each lobe in the renin molecule).<sup id="cite_ref-Gradman_42-0" class="reference"><a href="#cite_note-Gradman-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> A flexible flap made from amino acids formed in a <a href="/wiki/Beta_hairpin" title="Beta hairpin">β-hairpin</a> closes the active site by covering the cleft.<sup id="cite_ref-Lunney_43-0" class="reference"><a href="#cite_note-Lunney-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> The renin molecule contains both hydrophobic and <a href="/wiki/Hydrophilic" class="mw-redirect" title="Hydrophilic">hydrophilic</a> amino acids. The hydrophilic ones tend to be on the outside of the molecule, while the hydrophobic ones tend to be more on the inside and form the active site, a large hydrophobic cavity<sup id="cite_ref-Matter_44-0" class="reference"><a href="#cite_note-Matter-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> that can accommodate a <a href="/wiki/Ligand" title="Ligand">ligand</a> with at least seven residues. The principal connection between a ligand and the enzyme is by <a href="/wiki/Hydrogen_bond" title="Hydrogen bond">hydrogen bonding</a>. The residues are named after their places in the ligand, the residues closest to the cleavage site are named P1 and P1′ and they bind into the S1 and S1′ pockets, respectively. There are four S pockets, and three S′ pockets (table 1). The pockets alternate on either side of the backbone in the ligand. This alternation affects the orientation of the pockets, making the S3 and S1 pockets arrange together and the S2 pocket close to both S4 and S1′ pockets.<sup id="cite_ref-Lunney_43-1" class="reference"><a href="#cite_note-Lunney-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> Evidence suggests the closely arranged S1 and S3 pockets merge to form a spacious superpocket.<sup id="cite_ref-Yuan_45-0" class="reference"><a href="#cite_note-Yuan-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> Ligands that fill the superpocket have greater potency than those which do not, occupying increases <a href="/wiki/Potency_(pharmacology)" title="Potency (pharmacology)">potency</a> 200-fold. These ligands can be structurally diverse and form <a href="/wiki/Van_der_Waals_force" title="Van der Waals force">van der Waals</a> bonds to the surface of the superpocket.<sup id="cite_ref-Maibaum_11-2" class="reference"><a href="#cite_note-Maibaum-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> From the S3 pocket stretches a binding site distinct for renin, the S3<sup>sp</sup> subpocket.<sup id="cite_ref-Winiecka_41-1" class="reference"><a href="#cite_note-Winiecka-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> The S3<sup>sp</sup> subpocket can accommodate both hydrophobic and <a href="/wiki/Chemical_polarity" title="Chemical polarity">polar</a> residues, the pocket can accommodate three water molecules, but has also <a href="/wiki/Lipophilic" class="mw-redirect" title="Lipophilic">lipophilic</a> nature. The S3<sup>sp</sup> subpocket is not conformationally flexible, so the residues occupying the pocket must have certain characteristics. They can not be sterically demanding and must have reasonably high number of rotatable bonds and be able to connect with hydrogen bonds. The S2 pocket is large, bipartite and hydrophobic, but can accommodate both hydrophobic and polar ligands. This diversity of possible polarity offers the P2 residue opportunity of variation in its connection to the enzyme. The S3-S1 and the S3<sup>sp</sup> subpockets have been the main target of drug design, but recent discoveries have indicated other sites of interest. Interactions to the pockets on the S′ site have been proven to be critical for <a href="/wiki/Affinity_(pharmacology)" class="mw-redirect" title="Affinity (pharmacology)">affinity</a>, especially the S1′ and S2′, and <i>in vitro</i> tests have indicated the interaction with the flap region could be important to affinity.<sup id="cite_ref-Maibaum_11-3" class="reference"><a href="#cite_note-Maibaum-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p> <figure class="skin-invert-image" typeof="mw:File/Thumb"><a href="/wiki/File:Binding_pockets_that_aliskiren_connects_with..png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7a/Binding_pockets_that_aliskiren_connects_with..png/340px-Binding_pockets_that_aliskiren_connects_with..png" decoding="async" width="340" height="249" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7a/Binding_pockets_that_aliskiren_connects_with..png/510px-Binding_pockets_that_aliskiren_connects_with..png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/7a/Binding_pockets_that_aliskiren_connects_with..png/680px-Binding_pockets_that_aliskiren_connects_with..png 2x" data-file-width="1951" data-file-height="1427" /></a><figcaption>Binding pockets with which aliskiren connects</figcaption></figure> <table class="wikitable"> <caption>Characteristics of each pocket and the importance each residue in the ligand has to binding </caption> <tbody><tr> <th>Pocket </th> <th>Characteristics<sup id="cite_ref-Maibaum_11-4" class="reference"><a href="#cite_note-Maibaum-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </th> <th>Subsite </th> <th>Importance to binding<sup id="cite_ref-Maibaum_11-5" class="reference"><a href="#cite_note-Maibaum-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Wood2_46-0" class="reference"><a href="#cite_note-Wood2-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> </th></tr> <tr> <td>S4 </td> <td>Hydrophobic </td> <td>P4 </td> <td>Relatively important for binding </td></tr> <tr> <td>S3 </td> <td>Hydrophobic </td> <td>P3 </td> <td>Very important for binding </td></tr> <tr> <td>S3<sup>sp</sup> </td> <td>Equally hydrophobic/-philic </td> <td>P3 side chain </td> <td>Dramatically enhances binding affinity </td></tr> <tr> <td>S2 </td> <td>Large and hydrophobic </td> <td>P2 </td> <td>Important for binding </td></tr> <tr> <td>S1 </td> <td>Large and hydrophobic </td> <td>P1 </td> <td>NA </td></tr> <tr> <td>S1′ </td> <td>Primarily hydrophobic </td> <td>P1′ </td> <td>Critical for tight binding </td></tr> <tr> <td>S2′ </td> <td>Polar </td> <td>P2′ </td> <td>Critical for tight binding </td></tr> <tr> <td>S3′ </td> <td>NA </td> <td>P3′ </td> <td>Structure and presence is not as important </td></tr></tbody></table> <p>Interaction with both aspartic acids in the active site results in a higher affinity. Higher affinity also results by occupying more active site pockets. However, some pockets contribute more to the affinity than others. A hydrophobic interaction with the S3<sup>sp</sup> subpocket, S1 and S3 contribute to higher potency and affinity.<sup id="cite_ref-Politi_47-0" class="reference"><a href="#cite_note-Politi-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> By having a large and <a href="/wiki/Aromatic" class="mw-redirect" title="Aromatic">aromatic</a> residue in P3 increases inhibitory activity.<sup id="cite_ref-Akahane_48-0" class="reference"><a href="#cite_note-Akahane-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> Occupation of the S3<sup>sp</sup> subpocket can increase potency by 50-fold and results in tight binding.<sup id="cite_ref-Maibaum_11-6" class="reference"><a href="#cite_note-Maibaum-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>Example of binding to the renin inhibitor: Aliskiren is a peptide-like renin inhibitor and, unlike most, it is rather hydrophilic. It blocks the catalytic function of the enzyme by occupying the S3 to S2′ pockets, except the S2 pocket. Aliskiren also binds to the S3<sup>sp</sup> subpocket and because that pocket is distinct for renin, aliskiren does not inhibit other aspartic proteases, such as <a href="/wiki/Cathepsin_D" title="Cathepsin D">cathepsin D</a> and <a href="/wiki/Pepsin" title="Pepsin">pepsin</a>.<sup id="cite_ref-Wood2_46-1" class="reference"><a href="#cite_note-Wood2-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> The side chain of aliskiren binds the S3<sup>sp</sup> subpocket ideally, and leads to its quality as an inhibitor of human renin.<sup id="cite_ref-Maibaum_11-7" class="reference"><a href="#cite_note-Maibaum-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> The hydroxyl group in aliskiren forms a hydrogen bond with both oxygen atoms of the <a href="/wiki/Aspartic_acid" title="Aspartic acid">Asp</a>32. The <a href="/wiki/Amine" title="Amine">amine</a> group forms a hydrogen bond with the <a href="/wiki/Carboxylic_acid" title="Carboxylic acid">carboxylic acid</a> group of <a href="/wiki/Glycine" title="Glycine">Gly</a>217 and the oxygen atom of the Asp32. The <a href="/wiki/Methoxy" class="mw-redirect" title="Methoxy">methoxy</a> group on the aromatic ring fills the S3 pocket and may possibly form a hydrogen bond with a secondary amine group of <a href="/wiki/Tyrosine" title="Tyrosine">Tyr</a>14. The amide group forms a hydrogen bond with a secondary amine group of <a href="/wiki/Serine" title="Serine">Ser</a>76.<sup id="cite_ref-Politi_47-1" class="reference"><a href="#cite_note-Politi-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> The S1 and S1′ pockets are occupied by the two <a href="/wiki/Propyl" class="mw-redirect" title="Propyl">propyl</a> groups in positions P1 and P1′.<sup id="cite_ref-Yuan_45-1" class="reference"><a href="#cite_note-Yuan-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> The terminal amide in position P2′ anchors the amide tail in the active site by forming a hydrogen bond with <a href="/wiki/Arginine" title="Arginine">Arg</a>74 in the S2′ pocket.<sup id="cite_ref-Wu_49-0" class="reference"><a href="#cite_note-Wu-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Current_status">Current status</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=10" title="Edit section: Current status"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Aliskiren is effective in lowering blood pressure,<sup id="cite_ref-Jensen_7-10" class="reference"><a href="#cite_note-Jensen-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Staessen_28-3" class="reference"><a href="#cite_note-Staessen-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> but as of 20 April 2012 the US <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> (FDA) issued a warning of possible risks when using aliskiren or blood pressure medicines containing aliskiren with ACE inhibitors and angiotensin receptor blockers (ARBs) in patients with diabetes or kidney (renal) impairment. They advised that such drug combinations should not be used in patients with diabetes because of the risk of causing renal impairment, <a href="/wiki/Hypotension" title="Hypotension">hypotension</a>, and <a href="/wiki/Hyperkalemia" title="Hyperkalemia">hyperkalemia</a> and that aliskiren should not be used with ARBs or ACE inhibitors in patients with moderate to severe renal impairment (i.e., where glomerular filtration rate [GFR] < 60 mL/min). However, they also recommend that patients should not stop taking aliskiren without talking to a healthcare professional.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> </p><p>Aliskiren in combination with <a href="/wiki/Hydrochlorothiazide" title="Hydrochlorothiazide">hydrochlorothiazide</a> was approved by the FDA in 2008 under the tradename Tekturna HCT.<sup id="cite_ref-Novartis_51-0" class="reference"><a href="#cite_note-Novartis-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-FDA_52-0" class="reference"><a href="#cite_note-FDA-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> </p><p>In 2007, Actelion/Merck and Speedel companies announced they had the next generation of renin inhibitors in clinical research. The lead compound from Actelion/Merck has entered phase II trials. One compound from Speedel, SPP635, has completed phase IIa. The results showed it was safe and well tolerated over a four-week period, and it reduced blood pressure by 9.8 to 17.9 mmHg. In 2008, SPP635 was continuing phase II development for hypertension in <a href="/wiki/Diabetes_mellitus" class="mw-redirect" title="Diabetes mellitus">diabetic</a> patients. More renin inhibitors from Speedel are in clinical trials. Two of them, SPP1148 and SPP676, have entered phase I. Other are in <a href="/wiki/Pre-clinical_development" class="mw-redirect" title="Pre-clinical development">preclinical phases</a>, the compound SPP1234 and compounds from the SPP800 series.<sup id="cite_ref-Novartis_51-1" class="reference"><a href="#cite_note-Novartis-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p><p>The next generation of renin inhibitors have shown potential improvements over previous generations where bioavailability has increased up to 30% in humans, and they have better tissue <a href="/wiki/Distribution_(pharmacology)" title="Distribution (pharmacology)">distribution</a>.<sup id="cite_ref-Novartis_51-2" class="reference"><a href="#cite_note-Novartis-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup><sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Reliable_sources" title="Wikipedia:Reliable sources"><span title="The material near this tag relies on an unreliable source. (October 2011)">unreliable source</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=11" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 30em;"> <ul><li><a href="/wiki/ACE_inhibitor" title="ACE inhibitor">ACE inhibitor</a></li> <li><a href="/wiki/ACE_inhibitors_drug_design" class="mw-redirect" title="ACE inhibitors drug design">ACE inhibitors drug design</a></li> <li><a href="/wiki/Angiotensin" title="Angiotensin">Angiotensin</a></li> <li><a href="/wiki/Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">Angiotensin II receptor antagonist</a></li> <li><a href="/wiki/Beta_blocker" title="Beta blocker">Beta blocker</a></li> <li><a href="/wiki/Circulatory_system" title="Circulatory system">Circulatory system</a></li> <li><a href="/wiki/Discovery_and_development_of_angiotensin_receptor_blockers" title="Discovery and development of angiotensin receptor blockers">Discovery and development of angiotensin receptor blockers</a></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=12" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width reflist-columns-2"> <ol class="references"> <li id="cite_note-pmid15723979-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid15723979_1-0">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFGradmanSchmiederLinsNussberger2005" class="citation journal cs1">Gradman AH, Schmieder RE, Lins RL, Nussberger J, Chiang Y, Bedigian MP (March 2005). <a rel="nofollow" class="external text" href="http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15723979">"Aliskiren, a novel orally effective renin inhibitor, provides dose-dependent antihypertensive efficacy and placebo-like tolerability in hypertensive patients"</a>. <i>Circulation</i>. <b>111</b> (8): <span class="nowrap">1012–</span>8. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1161%2F01.CIR.0000156466.02908.ED">10.1161/01.CIR.0000156466.02908.ED</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15723979">15723979</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Circulation&rft.atitle=Aliskiren%2C+a+novel+orally+effective+renin+inhibitor%2C+provides+dose-dependent+antihypertensive+efficacy+and+placebo-like+tolerability+in+hypertensive+patients&rft.volume=111&rft.issue=8&rft.pages=%3Cspan+class%3D%22nowrap%22%3E1012-%3C%2Fspan%3E8&rft.date=2005-03&rft_id=info%3Adoi%2F10.1161%2F01.CIR.0000156466.02908.ED&rft_id=info%3Apmid%2F15723979&rft.aulast=Gradman&rft.aufirst=AH&rft.au=Schmieder%2C+RE&rft.au=Lins%2C+RL&rft.au=Nussberger%2C+J&rft.au=Chiang%2C+Y&rft.au=Bedigian%2C+MP&rft_id=http%3A%2F%2Fcirc.ahajournals.org%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D15723979&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARenin+inhibitor" class="Z3988"></span></span> </li> <li id="cite_note-CV_Pharmacology-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-CV_Pharmacology_2-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cvpharmacology.com/vasodilator/renin">"Renin Inhibitors"</a>. <i>CV Pharmacology</i><span class="reference-accessdate">. Retrieved <span class="nowrap">2020-07-22</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=CV+Pharmacology&rft.atitle=Renin+Inhibitors&rft_id=https%3A%2F%2Fwww.cvpharmacology.com%2Fvasodilator%2Frenin&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARenin+inhibitor" class="Z3988"></span></span> </li> <li id="cite_note-Nakano_Everitt_2018_pp._75–86-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-Nakano_Everitt_2018_pp._75–86_3-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFNakanoEveritt2018" class="citation book cs1">Nakano, Stephanie J.; Everitt, Melanie D. (2018). "Neurohormonal Axis and Natriuretic Peptides in Heart Failure". <i>Heart Failure in the Child and Young Adult</i>. Elsevier. pp. <span class="nowrap">75–</span>86. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fb978-0-12-802393-8.00006-5">10.1016/b978-0-12-802393-8.00006-5</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-12-802393-8" title="Special:BookSources/978-0-12-802393-8"><bdi>978-0-12-802393-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Neurohormonal+Axis+and+Natriuretic+Peptides+in+Heart+Failure&rft.btitle=Heart+Failure+in+the+Child+and+Young+Adult&rft.pages=%3Cspan+class%3D%22nowrap%22%3E75-%3C%2Fspan%3E86&rft.pub=Elsevier&rft.date=2018&rft_id=info%3Adoi%2F10.1016%2Fb978-0-12-802393-8.00006-5&rft.isbn=978-0-12-802393-8&rft.aulast=Nakano&rft.aufirst=Stephanie+J.&rft.au=Everitt%2C+Melanie+D.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARenin+inhibitor" class="Z3988"></span></span> </li> <li id="cite_note-TeachMePhysiology_2020-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-TeachMePhysiology_2020_4-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://teachmephysiology.com/urinary-system/regulation/the-renin-angiotensin-aldosterone-system/">"The Renin-Angiotensin-Aldosterone-System"</a>. <i>TeachMePhysiology</i>. 2020-04-28<span class="reference-accessdate">. Retrieved <span class="nowrap">2020-07-22</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=TeachMePhysiology&rft.atitle=The+Renin-Angiotensin-Aldosterone-System&rft.date=2020-04-28&rft_id=https%3A%2F%2Fteachmephysiology.com%2Furinary-system%2Fregulation%2Fthe-renin-angiotensin-aldosterone-system%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARenin+inhibitor" class="Z3988"></span></span> </li> <li id="cite_note-Nussberger_2005_pp._754–764-5"><span class="mw-cite-backlink"><b><a href="#cite_ref-Nussberger_2005_pp._754–764_5-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFNussberger2005" class="citation book cs1">Nussberger, Jürg (2005). "Renin Inhibitors". <i>Hypertension</i>. Elsevier. pp. <span class="nowrap">754–</span>764. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fb978-0-7216-0258-5.50162-9">10.1016/b978-0-7216-0258-5.50162-9</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7216-0258-5" title="Special:BookSources/978-0-7216-0258-5"><bdi>978-0-7216-0258-5</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Renin+Inhibitors&rft.btitle=Hypertension&rft.pages=%3Cspan+class%3D%22nowrap%22%3E754-%3C%2Fspan%3E764&rft.pub=Elsevier&rft.date=2005&rft_id=info%3Adoi%2F10.1016%2Fb978-0-7216-0258-5.50162-9&rft.isbn=978-0-7216-0258-5&rft.aulast=Nussberger&rft.aufirst=J%C3%BCrg&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARenin+inhibitor" class="Z3988"></span></span> </li> <li id="cite_note-Lambers_Heerspink_Fioretto_de_Zeeuw_2014_pp._222–234-6"><span class="mw-cite-backlink">^ <a href="#cite_ref-Lambers_Heerspink_Fioretto_de_Zeeuw_2014_pp._222–234_6-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Lambers_Heerspink_Fioretto_de_Zeeuw_2014_pp._222–234_6-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLambers_HeerspinkFiorettode_Zeeuw2014" class="citation book cs1">Lambers Heerspink, Hiddo J.; Fioretto, Paola; de Zeeuw, Dick (2014). "Pathogenesis, Pathophysiology, and Treatment of Diabetic Nephropathy". <i>National Kidney Foundation Primer on Kidney Diseases</i>. 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"Synthesis, biological evaluation and docking studies of octane–carboxamide based renin inhibitors with extended segments toward S3′ site of renin". <i>Bioorganic & Medicinal Chemistry</i>. <b>19</b> (14): <span class="nowrap">4238–</span>4249. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.bmc.2011.05.059">10.1016/j.bmc.2011.05.059</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/21708467">21708467</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Bioorganic+%26+Medicinal+Chemistry&rft.atitle=Synthesis%2C+biological+evaluation+and+docking+studies+of+octane%E2%80%93carboxamide+based+renin+inhibitors+with+extended+segments+toward+S3%E2%80%B2+site+of+renin&rft.volume=19&rft.issue=14&rft.pages=%3Cspan+class%3D%22nowrap%22%3E4238-%3C%2Fspan%3E4249&rft.date=2011&rft_id=info%3Adoi%2F10.1016%2Fj.bmc.2011.05.059&rft_id=info%3Apmid%2F21708467&rft.aulast=Wu&rft.aufirst=Y.&rft.au=Shi%2C+C.&rft.au=Sun%2C+X.&rft.au=Wu%2C+X.&rft.au=Sun%2C+H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARenin+inhibitor" class="Z3988"></span></span> </li> <li id="cite_note-50"><span class="mw-cite-backlink"><b><a href="#cite_ref-50">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20120422183424/http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm301120.htm">"Aliskiren-containing Medications: Drug Safety Comunication [sic]- New Warning and Contraindication"</a>. <i>www.fda.gov</i>. Archived from <a rel="nofollow" class="external text" href="https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm301120.htm">the original</a> on 2012-04-22.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.fda.gov&rft.atitle=Aliskiren-containing+Medications%3A+Drug+Safety+Comunication+%5Bsic%5D-+New+Warning+and+Contraindication&rft_id=https%3A%2F%2Fwww.fda.gov%2FSafety%2FMedWatch%2FSafetyInformation%2FSafetyAlertsforHumanMedicalProducts%2Fucm301120.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ARenin+inhibitor" class="Z3988"></span> </span> </li> <li id="cite_note-Novartis-51"><span class="mw-cite-backlink">^ <a href="#cite_ref-Novartis_51-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Novartis_51-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Novartis_51-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text">Speedel Acquiring an additional 51.7% stake and announcing plans for mandatory public tender offer.TRANSACTION OVERVIEW. (2008). From Novartis: <a rel="nofollow" class="external free" href="http://www.novartis.com/downloads/investors/presentations-events/other-events/2008/2008-07_speedel-backgrounder.pdf">http://www.novartis.com/downloads/investors/presentations-events/other-events/2008/2008-07_speedel-backgrounder.pdf</a></span> </li> <li id="cite_note-FDA-52"><span class="mw-cite-backlink"><b><a href="#cite_ref-FDA_52-0">^</a></b></span> <span class="reference-text">Tekturna HCT (aliskiren; hydrochlorothiazide) tablets. (2011). From US Food and Drug Administration: <a rel="nofollow" class="external free" href="http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022107s009lbl.pdf">http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022107s009lbl.pdf</a></span> </li> </ol></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Renin_inhibitor&action=edit&section=13" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid #aaa;font-size:88%;line-height:1.25em;background-color:var(--background-color-interactive-subtle,#f8f9fa);display:flow-root}.mw-parser-output .side-box-abovebelow,.mw-parser-output .side-box-text{padding:0.25em 0.9em}.mw-parser-output .side-box-image{padding:2px 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title="Anticoagulant">Anticoagulants</a></li> <li><a href="/wiki/Thrombolytic_drug" class="mw-redirect" title="Thrombolytic drug">Thrombolytics / fibrinolytics</a></li></ul></li> <li><a href="/wiki/Antihemorrhagic" title="Antihemorrhagic">Antihemorrhagics</a> <ul><li><a href="/wiki/Platelet" title="Platelet">Platelets</a></li> <li><a href="/wiki/Coagulation" title="Coagulation">Coagulants</a></li> <li><a href="/wiki/Antifibrinolytic" title="Antifibrinolytic">Antifibrinolytics</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Circulatory_system" title="Circulatory system">cardiovascular<br />system</a> (<a href="/wiki/ATC_code_C" title="ATC code C">C</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i>cardiac therapy / <a href="/wiki/Antianginal" title="Antianginal">antianginals</a></i> <ul><li><a href="/wiki/Cardiac_glycoside" title="Cardiac glycoside">Cardiac glycosides</a></li> <li><a href="/wiki/Antiarrhythmic_agent" title="Antiarrhythmic agent">Antiarrhythmics</a></li> <li><a href="/wiki/Cardiac_stimulant" title="Cardiac stimulant">Cardiac stimulants</a></li></ul></li> <li><a href="/wiki/Antihypertensive_drug" class="mw-redirect" title="Antihypertensive drug">Antihypertensives</a></li> <li><a href="/wiki/Diuretic" title="Diuretic">Diuretics</a></li> <li><a href="/wiki/Vasodilation" title="Vasodilation">Vasodilators</a></li> <li><a href="/wiki/Beta_blocker" title="Beta blocker">Beta blockers</a></li> <li><a href="/wiki/Calcium_channel_blocker" title="Calcium channel blocker">Calcium channel blockers</a></li> <li><i><a href="/wiki/Renin%E2%80%93angiotensin_system" title="Renin–angiotensin system">renin–angiotensin system</a></i> <ul><li><a href="/wiki/ACE_inhibitor" title="ACE inhibitor">ACE inhibitors</a></li> <li><a href="/wiki/Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">Angiotensin II receptor antagonists</a></li> <li><a class="mw-selflink selflink">Renin inhibitors</a></li></ul></li> <li><a href="/wiki/Hypolipidemic_agent" class="mw-redirect" title="Hypolipidemic agent">Antihyperlipidemics</a> <ul><li><a href="/wiki/Statin" title="Statin">Statins</a></li> <li><a href="/wiki/Fibrate" title="Fibrate">Fibrates</a></li> <li><a href="/wiki/Bile_acid_sequestrant" title="Bile acid sequestrant">Bile acid sequestrants</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_skin" title="Human skin">skin</a> (<a href="/wiki/ATC_code_D" title="ATC code D">D</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Emollient" class="mw-redirect" title="Emollient">Emollients</a></li> <li><a href="/wiki/Cicatrizant" class="mw-redirect" title="Cicatrizant">Cicatrizants</a></li> <li><a href="/wiki/Antipruritic" title="Antipruritic">Antipruritics</a></li> <li><a href="/wiki/Antipsoriatic" class="mw-redirect" title="Antipsoriatic">Antipsoriatics</a></li> <li><a href="/wiki/ATC_code_D09" title="ATC code D09">Medicated dressings</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Genitourinary_system" title="Genitourinary system">genitourinary<br />system</a> (<a href="/wiki/ATC_code_G" title="ATC code G">G</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hormonal_contraception" title="Hormonal contraception">Hormonal contraception</a></li> <li><a href="/wiki/Fertility_medication" title="Fertility medication">Fertility agents</a></li> <li><a href="/wiki/Selective_estrogen_receptor_modulator" title="Selective estrogen receptor modulator">Selective estrogen receptor modulators</a></li> <li><a href="/wiki/Sex_steroid" class="mw-redirect" title="Sex steroid">Sex hormones</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Endocrine_system" title="Endocrine system">endocrine<br />system</a> (<a href="/wiki/ATC_code_H" title="ATC code H">H</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypothalamic%E2%80%93pituitary_hormone" title="Hypothalamic–pituitary hormone">Hypothalamic–pituitary hormones</a></li> <li><a href="/wiki/Corticosteroid" title="Corticosteroid">Corticosteroids</a> <ul><li><a href="/wiki/Glucocorticoid" title="Glucocorticoid">Glucocorticoids</a></li> <li><a href="/wiki/Mineralocorticoid" title="Mineralocorticoid">Mineralocorticoids</a></li></ul></li> <li><a href="/wiki/Sex_steroid" class="mw-redirect" title="Sex steroid">Sex hormones</a></li> <li><a href="/wiki/Thyroid_hormone" class="mw-redirect" title="Thyroid hormone">Thyroid hormones</a> / <a href="/wiki/Antithyroid_agent" title="Antithyroid agent">Antithyroid agents</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Infection" title="Infection">infections</a> and<br /><a href="https://en.wiktionary.org/wiki/infestation" class="extiw" title="wikt:infestation">infestations</a> (<a href="/wiki/ATC_code_J" title="ATC code J">J</a>, <a href="/wiki/ATC_code_P" title="ATC code P">P</a>, <a href="/wiki/ATCvet_code_QI" title="ATCvet code QI">QI</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Antimicrobial" title="Antimicrobial">Antimicrobials</a>: <a href="/wiki/Antibacterial" class="mw-redirect" title="Antibacterial">Antibacterials</a> (<a href="/wiki/Antimycobacterial" title="Antimycobacterial">Antimycobacterials</a>)</li> <li><a href="/wiki/Antifungal_drug" class="mw-redirect" title="Antifungal drug">Antifungals</a></li> <li><a href="/wiki/Antiviral_drug" title="Antiviral drug">Antivirals</a></li> <li><a href="/wiki/Antiparasitic" title="Antiparasitic">Antiparasitics</a> <ul><li><a href="/wiki/Antiprotozoal_agent" class="mw-redirect" title="Antiprotozoal agent">Antiprotozoals</a></li> <li><a href="/wiki/Anthelmintic" title="Anthelmintic">Anthelmintics</a></li> <li><a href="/wiki/Ectoparasiticide" title="Ectoparasiticide">Ectoparasiticides</a></li></ul></li> <li><a href="/wiki/Intravenous_immunoglobulin" class="mw-redirect" title="Intravenous immunoglobulin">Intravenous immunoglobulin</a></li> <li><a href="/wiki/Vaccine" title="Vaccine">Vaccines</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Malignant" class="mw-redirect" title="Malignant">malignant</a> disease<br />(<a href="/wiki/ATC_code_L" title="ATC code L">L01–L02</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Chemotherapy" title="Chemotherapy">Anticancer agents</a> <ul><li><a href="/wiki/Antimetabolite" title="Antimetabolite">Antimetabolites</a></li> <li><a href="/wiki/Alkylating_antineoplastic_agent" title="Alkylating antineoplastic agent">Alkylating</a></li> <li><a href="/wiki/Spindle_poison" title="Spindle poison">Spindle poisons</a></li> <li><a href="/wiki/Antineoplastic" class="mw-redirect" title="Antineoplastic">Antineoplastic</a></li> <li><a href="/wiki/Topoisomerase_inhibitor" title="Topoisomerase inhibitor">Topoisomerase inhibitors</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Immune_system" title="Immune system">immune</a> disease<br />(<a href="/wiki/ATC_code_L" title="ATC code L">L03–L04</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Immunomodulator" class="mw-redirect" title="Immunomodulator">Immunomodulators</a> <ul><li><a href="/wiki/Immunostimulant" title="Immunostimulant">Immunostimulants</a></li> <li><a href="/wiki/Immunosuppressive_drug" title="Immunosuppressive drug">Immunosuppressants</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Muscle" title="Muscle">muscles</a>, <a href="/wiki/Bone" title="Bone">bones</a>,<br />and <a href="/wiki/Joint" title="Joint">joints</a> (<a href="/wiki/ATC_code_M" title="ATC code M">M</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anabolic_steroid" title="Anabolic steroid">Anabolic steroids</a></li> <li><a href="/wiki/Anti-inflammatory" title="Anti-inflammatory">Anti-inflammatories</a> <ul><li><a href="/wiki/Non-steroidal_anti-inflammatory_drug" class="mw-redirect" title="Non-steroidal anti-inflammatory drug">Non-steroidal anti-inflammatory drugs</a></li></ul></li> <li><a href="/wiki/Disease-modifying_antirheumatic_drug" title="Disease-modifying antirheumatic drug">Antirheumatics</a></li> <li><a href="/wiki/Corticosteroid" title="Corticosteroid">Corticosteroids</a></li> <li><a href="/wiki/Muscle_relaxant" title="Muscle relaxant">Muscle relaxants</a></li> <li><a href="/wiki/Bisphosphonate" title="Bisphosphonate">Bisphosphonates</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_brain" title="Human brain">brain</a> and<br /><a href="/wiki/Nervous_system" title="Nervous system">nervous system</a> (<a href="/wiki/ATC_code_N" title="ATC code N">N</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Analgesic" title="Analgesic">Analgesics</a></li> <li><a href="/wiki/Anesthetic" title="Anesthetic">Anesthetics</a> <ul><li><a href="/wiki/General_anaesthetic" title="General anaesthetic">General</a></li> <li><a href="/wiki/Local_anesthetic" title="Local anesthetic">Local</a></li></ul></li> <li><a href="/wiki/Anorectic" title="Anorectic">Anorectics</a></li> <li><a href="/wiki/Antihyperkinetic" class="mw-redirect" title="Antihyperkinetic">Anti-ADHD agents</a></li> <li><a href="/wiki/Addiction_medicine" title="Addiction medicine">Antiaddictives</a></li> <li><a href="/wiki/Anticonvulsant" title="Anticonvulsant">Anticonvulsants</a></li> <li><a href="/wiki/Antidementia_drug" class="mw-redirect" title="Antidementia drug">Antidementia agents</a></li> <li><a href="/wiki/Antidepressant" title="Antidepressant">Antidepressants</a></li> <li><a href="/wiki/Antimigraine_drug" title="Antimigraine drug">Antimigraine agents</a></li> <li><a href="/wiki/Management_of_Parkinson%27s_disease#Medication" title="Management of Parkinson's disease">Antiparkinson agents</a></li> <li><a href="/wiki/Antipsychotic" title="Antipsychotic">Antipsychotics</a></li> <li><a href="/wiki/Anxiolytic" title="Anxiolytic">Anxiolytics</a></li> <li><a href="/wiki/Aphrodisiac" title="Aphrodisiac">Aphrodisiacs</a></li> <li><a href="/wiki/Depressant" title="Depressant">Depressants</a></li> <li><a href="/wiki/Entactogen" class="mw-redirect" title="Entactogen">Entactogens</a></li> <li><a href="/wiki/Entheogen" title="Entheogen">Entheogens</a></li> <li><a href="/wiki/Euphoria" title="Euphoria">Euphoriants</a></li> <li><a href="/wiki/Psychedelics,_dissociatives_and_deliriants" class="mw-redirect" title="Psychedelics, dissociatives and deliriants">Hallucinogens</a> <ul><li><a href="/wiki/Psychedelic_drug" title="Psychedelic drug">Psychedelics</a></li> <li><a href="/wiki/Dissociative" title="Dissociative">Dissociatives</a></li> <li><a href="/wiki/Deliriant" title="Deliriant">Deliriants</a></li></ul></li> <li><a href="/wiki/Hypnotic" title="Hypnotic">Hypnotics</a> / <a href="/wiki/Sedative" title="Sedative">Sedatives</a></li> <li><a href="/wiki/Mood_stabilizer" title="Mood stabilizer">Mood stabilizers</a></li> <li><a href="/wiki/Motivation-enhancing_drug" title="Motivation-enhancing drug">Motivation-enhancing drug</a></li> <li><a href="/wiki/Neuroprotective" class="mw-redirect" title="Neuroprotective">Neuroprotectives</a></li> <li><a href="/wiki/Nootropic" title="Nootropic">Nootropics</a></li> <li><a href="/wiki/Neurotoxin" title="Neurotoxin">Neurotoxins</a></li> <li><a href="/wiki/Orexigenic" class="mw-redirect" title="Orexigenic">Orexigenics</a></li> <li><a href="/wiki/Serenic" title="Serenic">Serenics</a></li> <li><a href="/wiki/Stimulant" title="Stimulant">Stimulants</a></li> <li><a href="/wiki/Wakefulness-promoting_agent" title="Wakefulness-promoting agent">Wakefulness-promoting agents</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Respiratory_system" title="Respiratory system">respiratory<br />system</a> (<a href="/wiki/ATC_code_R" title="ATC code R">R</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Decongestant" title="Decongestant">Decongestants</a></li> <li><a href="/wiki/Bronchodilator" title="Bronchodilator">Bronchodilators</a></li> <li><a href="/wiki/Cough_medicine" class="mw-redirect" title="Cough medicine">Cough medicines</a></li> <li><a href="/wiki/H1_antagonist" title="H1 antagonist">H<sub>1</sub> antagonists</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sense" title="Sense">sensory organs</a> (<a href="/wiki/ATC_code_S" title="ATC code S">S</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ophthalmology" title="Ophthalmology">Ophthalmologicals</a></li> <li><a href="/wiki/Otology" title="Otology">Otologicals</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">other <a href="/wiki/Anatomical_Therapeutic_Chemical_Classification_System" title="Anatomical Therapeutic Chemical Classification System">ATC</a> (<a href="/wiki/ATC_code_V" title="ATC code V">V</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Antidote" title="Antidote">Antidotes</a></li> <li><a href="/wiki/Contrast_medium" class="mw-redirect" title="Contrast medium">Contrast media</a></li> <li><a href="/wiki/Radiopharmacology" title="Radiopharmacology">Radiopharmaceuticals</a></li> <li><a href="/wiki/Dressing_(medicine)" title="Dressing (medicine)">Dressings</a></li> <li><a href="/wiki/Senotherapeutics" class="mw-redirect" title="Senotherapeutics">Senotherapeutics</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><span class="noviewer" typeof="mw:File"><span title="Category"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/31px-Symbol_category_class.svg.png 2x" data-file-width="180" data-file-height="185" /></span></span> <a href="/wiki/Category:Drugs" title="Category:Drugs">Drugs</a></li> <li><a href="/wiki/Category:Pharmacological_classification_systems" title="Category:Pharmacological classification systems">Pharmacological classification systems</a></li> <li><a href="/wiki/Category:ATC_codes" title="Category:ATC codes">ATC codes</a></li> <li><span class="noviewer" typeof="mw:File"><a href="/wiki/File:Symbol_portal_class.svg" class="mw-file-description" title="Portal"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/16px-Symbol_portal_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/23px-Symbol_portal_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/31px-Symbol_portal_class.svg.png 2x" data-file-width="180" data-file-height="185" /></a></span> <a href="/wiki/Portal:Medicine" title="Portal:Medicine">Medicine portal</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-labelledby="Antihypertensive_drugs_acting_on_the_renin–angiotensin_system_(C09)651" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Agents_acting_on_the_renin%E2%80%93angiotensin_system" title="Template:Agents acting on the renin–angiotensin system"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Agents_acting_on_the_renin%E2%80%93angiotensin_system" title="Template talk:Agents acting on the renin–angiotensin system"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Agents_acting_on_the_renin%E2%80%93angiotensin_system" title="Special:EditPage/Template:Agents acting on the renin–angiotensin system"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Antihypertensive_drugs_acting_on_the_renin–angiotensin_system_(C09)651" style="font-size:114%;margin:0 4em"><a href="/wiki/Antihypertensive_drug" class="mw-redirect" title="Antihypertensive drug">Antihypertensive drugs</a> acting on the <a href="/wiki/Renin%E2%80%93angiotensin_system" title="Renin–angiotensin system">renin–angiotensin system</a> (<a href="/wiki/ATC_code_C09" title="ATC code C09">C09</a>)</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/ACE_inhibitor" title="ACE inhibitor">ACE inhibitors</a><br />("-pril")</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/ACE_inhibitor#Sulfhydryl-containing_agents" title="ACE inhibitor">Sulfhydryl-containing</a>:</i> <a href="/wiki/Captopril" title="Captopril">Captopril</a></li> <li><a href="/wiki/Rentiapril" title="Rentiapril">Rentiapril</a></li> <li><a href="/wiki/Zofenopril" title="Zofenopril">Zofenopril</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Zofenopril/nebivolol&action=edit&redlink=1" class="new" title="Zofenopril/nebivolol (page does not exist)">+nebivolol</a>)</li> <li><i><a href="/wiki/ACE_inhibitor#Dicarboxylate-containing_agents" title="ACE inhibitor">Dicarboxylate-containing</a>: </i><a href="/wiki/Enalapril" title="Enalapril">Enalapril</a><sup>#</sup> (<a href="/w/index.php?title=Enalapril/lercanidipine&action=edit&redlink=1" class="new" title="Enalapril/lercanidipine (page does not exist)">+lercanidipine</a>, <a href="/w/index.php?title=Enalapril/nitrendipine&action=edit&redlink=1" class="new" title="Enalapril/nitrendipine (page does not exist)">+nitrendipine</a>)</li> <li><a href="/wiki/Benazepril" title="Benazepril">Benazepril</a><span class="nowrap"> </span>(<a href="/wiki/Benazepril/amlodipine" class="mw-redirect" title="Benazepril/amlodipine">+amlodipine</a>, <a href="/w/index.php?title=Benazepril/pimobendan&action=edit&redlink=1" class="new" title="Benazepril/pimobendan (page does not exist)">+pimobendan</a>)</li> <li><a href="/wiki/Cilazapril" title="Cilazapril">Cilazapril</a></li> <li><a href="/wiki/Delapril" title="Delapril">Delapril</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Delapril/manidipine&action=edit&redlink=1" class="new" title="Delapril/manidipine (page does not exist)">+manidipine</a>)</li> <li><a href="/wiki/Imidapril" title="Imidapril">Imidapril</a></li> <li><a href="/wiki/Lisinopril" title="Lisinopril">Lisinopril</a><span class="nowrap"> </span>(<a href="/wiki/Lisinopril/amlodipine" title="Lisinopril/amlodipine">+amlodipine</a>, <a href="/wiki/Lisinopril/hydrochlorothiazide" title="Lisinopril/hydrochlorothiazide">+HCT</a>)</li> <li><a href="/wiki/Moexipril" title="Moexipril">Moexipril</a></li> <li><a href="/wiki/Perindopril" title="Perindopril">Perindopril</a><span class="nowrap"> </span>(<a href="/wiki/Perindopril/amlodipine" class="mw-redirect" title="Perindopril/amlodipine">+amlodipine</a>, <a href="/w/index.php?title=Perindopril/bisoprolol&action=edit&redlink=1" class="new" title="Perindopril/bisoprolol (page does not exist)">+bisoprolol</a>, <a href="/wiki/Perindopril/indapamide" title="Perindopril/indapamide">+indapamide</a>, <a href="/w/index.php?title=Perindopril/amlodipine/indapamide&action=edit&redlink=1" class="new" title="Perindopril/amlodipine/indapamide (page does not exist)">+amlodipine and indapamide</a>, <a href="/w/index.php?title=Perindopril/bisoprolol/amlodipine&action=edit&redlink=1" class="new" title="Perindopril/bisoprolol/amlodipine (page does not exist)">+bisoprolol and amlodipine</a>, <a href="/w/index.php?title=Perindopril/bisoprolol/amlodipine/indapamide&action=edit&redlink=1" class="new" title="Perindopril/bisoprolol/amlodipine/indapamide (page does not exist)">+bisoprolol, amlodipine, and indapamide</a>)</li> <li><a href="/wiki/Quinapril" title="Quinapril">Quinapril</a><span class="nowrap"> </span>(<a href="/wiki/Quinapril/hydrochlorothiazide" class="mw-redirect" title="Quinapril/hydrochlorothiazide">+HCT</a>)</li> <li><a href="/wiki/Ramipril" title="Ramipril">Ramipril</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Ramipril/amlodipine&action=edit&redlink=1" class="new" title="Ramipril/amlodipine (page does not exist)">+amlodipine</a>, <a href="/w/index.php?title=Ramipril/amlodipine/hydrochlorothiazide&action=edit&redlink=1" class="new" title="Ramipril/amlodipine/hydrochlorothiazide (page does not exist)">+amlodipine and HCT</a>, <a href="/w/index.php?title=Ramipril/bisoprolol&action=edit&redlink=1" class="new" title="Ramipril/bisoprolol (page does not exist)">+bisoprolol</a>, <a href="/w/index.php?title=Ramipril/felodipine&action=edit&redlink=1" class="new" title="Ramipril/felodipine (page does not exist)">+felodipine</a>)</li> <li><a href="/wiki/Spirapril" title="Spirapril">Spirapril</a></li> <li><a href="/wiki/Temocapril" title="Temocapril">Temocapril</a></li> <li><a href="/wiki/Trandolapril" title="Trandolapril">Trandolapril</a><span class="nowrap"> </span>(<a href="/wiki/Trandolapril/verapamil" title="Trandolapril/verapamil">+verapamil</a>)</li> <li><i><a href="/wiki/ACE_inhibitor#Phosphonate-containing_agents" title="ACE inhibitor">Phosphonate-containing</a></i>: <a href="/wiki/Ceronapril" title="Ceronapril">Ceronapril</a></li> <li><a href="/wiki/Fosinopril" title="Fosinopril">Fosinopril</a><span class="nowrap"> </span>(<a href="/wiki/Fosinopril/hydrochlorothiazide" class="mw-redirect" title="Fosinopril/hydrochlorothiazide">+HCT</a>)</li> <li><i>Other/ungrouped:</i> <a href="/wiki/Alacepril" title="Alacepril">Alacepril</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">AIIRAs</a><br />("-sartan")</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Azilsartan" title="Azilsartan">Azilsartan</a></li> <li><a href="/wiki/Candesartan" title="Candesartan">Candesartan</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Candesartan/amlodipine&action=edit&redlink=1" class="new" title="Candesartan/amlodipine (page does not exist)">+amlodipine</a>, <a href="/w/index.php?title=Candesartan/amlodipine/hydrochlorothiazide&action=edit&redlink=1" class="new" title="Candesartan/amlodipine/hydrochlorothiazide (page does not exist)">+amlodipine and HCT</a>)</li> <li><a href="/wiki/Eprosartan" title="Eprosartan">Eprosartan</a></li> <li><a href="/wiki/Fimasartan" title="Fimasartan">Fimasartan</a></li> <li><a href="/wiki/Irbesartan" title="Irbesartan">Irbesartan</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Irbesartan/amlodipine&action=edit&redlink=1" class="new" title="Irbesartan/amlodipine (page does not exist)">+amlodipine</a>, <a href="/w/index.php?title=Irbesartan/amlodipine/hydrochlorothiazide&action=edit&redlink=1" class="new" title="Irbesartan/amlodipine/hydrochlorothiazide (page does not exist)">+amlodipine and HCT</a>, <a href="/wiki/Irbesartan/hydrochlorothiazide" class="mw-redirect" title="Irbesartan/hydrochlorothiazide">+HCT</a>)</li> <li><a href="/wiki/Losartan" title="Losartan">Losartan</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Losartan/amlodipine&action=edit&redlink=1" class="new" title="Losartan/amlodipine (page does not exist)">+amlodipine</a>, <a href="/wiki/Losartan/hydrochlorothiazide" title="Losartan/hydrochlorothiazide">+HCT</a>)</li> <li><a href="/wiki/Olmesartan" title="Olmesartan">Olmesartan</a><span class="nowrap"> </span>(<a href="/wiki/Amlodipine/olmesartan" title="Amlodipine/olmesartan">+amlodipine</a>, <a href="/wiki/Olmesartan/amlodipine/hydrochlorothiazide" title="Olmesartan/amlodipine/hydrochlorothiazide">+amlodipine and HCT</a>, <a href="/wiki/Olmesartan/hydrochlorothiazide" title="Olmesartan/hydrochlorothiazide">+HCT</a>)</li> <li><a href="/wiki/Tasosartan" title="Tasosartan">Tasosartan</a><sup>§</sup></li> <li><a href="/wiki/Telmisartan" title="Telmisartan">Telmisartan</a><span class="nowrap"> </span>(<a href="/wiki/Telmisartan/amlodipine" title="Telmisartan/amlodipine">+amlodipine</a>, <a href="/w/index.php?title=Telmisartan/amlodipine/hydrochlorothiazide&action=edit&redlink=1" class="new" title="Telmisartan/amlodipine/hydrochlorothiazide (page does not exist)">+amlodipine and HCT</a>, <a href="/wiki/Telmisartan/hydrochlorothiazide" title="Telmisartan/hydrochlorothiazide">+HCT</a>)</li> <li><a href="/wiki/Valsartan" title="Valsartan">Valsartan</a><span class="nowrap"> </span>(<a href="/w/index.php?title=Valsartan/aliskiren&action=edit&redlink=1" class="new" title="Valsartan/aliskiren (page does not exist)">+aliskiren</a>, <a href="/wiki/Amlodipine/valsartan" title="Amlodipine/valsartan">+amlodipine</a>, <a href="/wiki/Amlodipine/valsartan/hydrochlorothiazide" class="mw-redirect" title="Amlodipine/valsartan/hydrochlorothiazide">+amlodipine and HCT</a>, <a href="/wiki/Valsartan/hydrochlorothiazide" title="Valsartan/hydrochlorothiazide">+HCT</a>, <a href="/w/index.php?title=Valsartan/lercanidipine&action=edit&redlink=1" class="new" title="Valsartan/lercanidipine (page does not exist)">+lercanidipine</a>, <a href="/wiki/Nebivolol/valsartan" title="Nebivolol/valsartan">+nebivolol</a>, <a href="/wiki/Sacubitril/valsartan" title="Sacubitril/valsartan">+sacubitril</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink selflink">Renin inhibitors</a><br />("-kiren")</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Aliskiren" title="Aliskiren">Aliskiren</a><span class="nowrap"> </span>(<a href="/wiki/Aliskiren/amlodipine" title="Aliskiren/amlodipine">+amlodipine</a>, <a href="/wiki/Aliskiren/hydrochlorothiazide" title="Aliskiren/hydrochlorothiazide">+HCT</a>, <a href="/wiki/Aliskiren/amlodipine/hydrochlorothiazide" title="Aliskiren/amlodipine/hydrochlorothiazide">+amlodipine and HCT</a>)</li> <li><a href="/wiki/Remikiren" title="Remikiren">Remikiren</a><sup>§</sup></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Dual <a href="/wiki/Angiotensin-converting_enzyme" title="Angiotensin-converting enzyme">ACE</a>/<a href="/wiki/Neprilysin" title="Neprilysin">NEP</a> inhibitors</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gemopatrilat" title="Gemopatrilat">Gemopatrilat</a></li> <li><a href="/w/index.php?title=Ilepatril&action=edit&redlink=1" class="new" title="Ilepatril (page does not exist)">Ilepatril</a></li> <li><a href="/wiki/Omapatrilat" title="Omapatrilat">Omapatrilat</a></li> <li><a href="/w/index.php?title=Sampatrilat&action=edit&redlink=1" class="new" title="Sampatrilat (page does not exist)">Sampatrilat</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neprilysin" title="Neprilysin">Neprilysin</a> inhibitors</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sacubitril" title="Sacubitril">Sacubitril</a><span class="nowrap"> </span>(<a href="/wiki/Sacubitril/valsartan" title="Sacubitril/valsartan">+valsartan</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sparsentan" title="Sparsentan">Sparsentan</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2" style="padding: 0px;"><div><div class="hlist"> <ul><li><sup>#</sup><a href="/wiki/WHO_Model_List_of_Essential_Medicines" title="WHO Model List of Essential Medicines">WHO-EM</a></li> <li><sup>‡</sup><a href="/wiki/List_of_withdrawn_drugs" title="List of withdrawn drugs">Withdrawn</a> from market</li> <li><a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trials</a>: <ul><li><sup>†</sup><a href="/wiki/Phases_of_clinical_research#Phase_III" title="Phases of clinical research">Phase III</a></li> <li><sup>§</sup>Never to phase III</li></ul></li></ul> </div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Pharmacology:_enzyme_inhibition70" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Enzyme_inhibition" title="Template:Enzyme inhibition"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Enzyme_inhibition" title="Template talk:Enzyme inhibition"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Enzyme_inhibition" title="Special:EditPage/Template:Enzyme inhibition"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Pharmacology:_enzyme_inhibition70" style="font-size:114%;margin:0 4em"><a href="/wiki/Pharmacology" title="Pharmacology">Pharmacology</a>: <a href="/wiki/Enzyme_inhibitor" title="Enzyme inhibitor">enzyme inhibition</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Class</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Competitive_inhibition" title="Competitive inhibition">Competitive inhibition</a></li> <li><a href="/wiki/Uncompetitive_inhibitor" class="mw-redirect" title="Uncompetitive inhibitor">Uncompetitive inhibition</a></li> <li><a href="/wiki/Non-competitive_inhibition" title="Non-competitive inhibition">Non-competitive inhibition</a></li> <li><a href="/wiki/Suicide_inhibition" title="Suicide inhibition">Suicide inhibition</a></li> <li><a href="/wiki/Mixed_inhibition" title="Mixed inhibition">Mixed inhibition</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Substrate</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Oxidoreductase" title="Oxidoreductase">Oxidoreductase</a> (EC 1)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>1.1 <a href="/wiki/Aldose_reductase_inhibitor" title="Aldose reductase inhibitor">Aldose reductase</a></li> <li><a href="/wiki/Statin" title="Statin">HMG-CoA reductase</a></li></ul> <ul><li>1.3 <a href="/wiki/5%CE%B1-Reductase_inhibitor" title="5α-Reductase inhibitor">5α-Reductase</a></li></ul> <ul><li>1.4 <a href="/wiki/Monoamine_oxidase_inhibitor" title="Monoamine oxidase inhibitor">Monoamine oxidase</a></li></ul> <ul><li>1.5 <a href="/wiki/Dihydrofolate_reductase_inhibitor" title="Dihydrofolate reductase inhibitor">Dihydrofolate reductase</a></li></ul> <ul><li>1.13 <a href="/wiki/Lipoxygenase_inhibitor" class="mw-redirect" title="Lipoxygenase inhibitor">Lipoxygenase</a></li></ul> <ul><li>1.14 <a href="/wiki/Aromatase_inhibitor" title="Aromatase inhibitor">Aromatase</a></li> <li><a href="/wiki/COX-2_inhibitor" class="mw-redirect" title="COX-2 inhibitor">COX-2</a></li></ul> <ul><li>1.17 <a href="/wiki/Xanthine_oxidase_inhibitor" title="Xanthine oxidase inhibitor">Xanthine oxidase</a></li> <li><a href="/wiki/Ribonucleotide_reductase_inhibitor" title="Ribonucleotide reductase inhibitor">Ribonucleotide reductase</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Transferase" title="Transferase">Transferase</a> (EC 2)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>2.1 <a href="/wiki/COMT_inhibitor" class="mw-redirect" title="COMT inhibitor">COMT</a></li> <li><a href="/wiki/Thymidylate_synthase_inhibitor" title="Thymidylate synthase inhibitor">Thymidylate synthase</a></li></ul> <ul><li>2.4 <a href="/wiki/PARP_inhibitor" title="PARP inhibitor">PARP</a></li></ul> <ul><li>2.5 <a href="/wiki/Dihydropteroate_synthase_inhibitor" title="Dihydropteroate synthase inhibitor">Dihydropteroate synthetase</a></li> <li><a href="/wiki/Farnesyltransferase_inhibitor" title="Farnesyltransferase inhibitor">Farnesyltransferase</a></li></ul> <ul><li>2.6 <a href="/wiki/GABA_transaminase_inhibitor" title="GABA transaminase inhibitor">GABA transaminase</a></li></ul> <ul><li>2.7 <a href="/wiki/Nucleotidyltransferase" title="Nucleotidyltransferase">Nucleotidyltransferase</a> <ul><li><a href="/wiki/Integrase_inhibitor" title="Integrase inhibitor">Integrase</a></li> <li><a href="/wiki/Reverse-transcriptase_inhibitor" title="Reverse-transcriptase inhibitor">Reverse transcriptase</a></li></ul></li> <li><a href="/wiki/Protein_kinase_inhibitor" title="Protein kinase inhibitor">Protein kinase</a> <ul><li><a href="/wiki/Tyrosine_kinase_inhibitor" title="Tyrosine kinase inhibitor">Tyrosine kinase</a> <ul><li><a href="/wiki/Janus_kinase_inhibitor" title="Janus kinase inhibitor">Janus kinase</a></li></ul></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hydrolase" title="Hydrolase">Hydrolase</a> (EC 3)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>3.1 <a href="/wiki/Phosphodiesterase_inhibitor" title="Phosphodiesterase inhibitor">Phosphodiesterase</a></li> <li><a href="/wiki/Acetylcholinesterase_inhibitor" title="Acetylcholinesterase inhibitor">Acetylcholinesterase</a></li> <li><a href="/wiki/Ribonuclease_inhibitor" title="Ribonuclease inhibitor">Ribonuclease</a></li></ul> <ul><li>3.2 <a href="/wiki/Polygalacturonase_inhibitor" title="Polygalacturonase inhibitor">Polygalacturonase</a></li> <li><a href="/wiki/Neuraminidase_inhibitor" title="Neuraminidase inhibitor">Neuraminidase</a></li> <li><a href="/wiki/Alpha-glucosidase_inhibitor" title="Alpha-glucosidase inhibitor">Alpha-glucosidase</a></li></ul> <ul><li>3.4 <a href="/wiki/Protease_inhibitor_(pharmacology)" title="Protease inhibitor (pharmacology)">Protease</a>: <a href="/wiki/Exopeptidase_inhibitor" title="Exopeptidase inhibitor">Exopeptidase</a> <ul><li><a href="/wiki/Dipeptidyl_peptidase-4_inhibitor" title="Dipeptidyl peptidase-4 inhibitor">DPP-4</a></li> <li><a href="/wiki/ACE_inhibitor" title="ACE inhibitor">ACE</a></li></ul></li> <li><a href="/wiki/Endopeptidase_inhibitor" title="Endopeptidase inhibitor">Endopeptidase</a> <ul><li><a href="/wiki/Trypsin_inhibitor" title="Trypsin inhibitor">Trypsin</a></li> <li><a class="mw-selflink selflink">Renin</a></li></ul></li> <li><i>Mixed</i> <ul><li><a href="/wiki/Enkephalinase_inhibitor" title="Enkephalinase inhibitor">Enkephalinase</a></li> <li><a href="/wiki/Matrix_metalloproteinase_inhibitor" title="Matrix metalloproteinase inhibitor">Matrix metalloproteinase</a></li> <li><a href="/wiki/Oxytocinase_inhibitor" class="mw-redirect" title="Oxytocinase inhibitor">Oxytocinase</a></li></ul></li></ul> <ul><li>3.5 <a href="/wiki/Histone_deacetylase_inhibitor" title="Histone deacetylase inhibitor">Histone deacetylase</a></li> <li><a href="/wiki/Beta-lactamase_inhibitor" class="mw-redirect" title="Beta-lactamase inhibitor">Beta-lactamase</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Lyase" title="Lyase">Lyase</a> (EC 4)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>4.1 <a href="/wiki/Dopa_decarboxylase_inhibitor" class="mw-redirect" title="Dopa decarboxylase inhibitor">Dopa decarboxylase</a></li></ul> <ul><li>4.2 <a href="/wiki/Carbonic_anhydrase_inhibitor" title="Carbonic anhydrase inhibitor">Carbonic anhydrase</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Miscellaneous</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Steroidogenesis_inhibitor" title="Steroidogenesis inhibitor">Steroidogenesis inhibitor</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Angiotensin_receptor_modulators469" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Angiotensin_receptor_modulators" title="Template:Angiotensin receptor modulators"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Angiotensin_receptor_modulators" title="Template talk:Angiotensin receptor modulators"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Angiotensin_receptor_modulators" title="Special:EditPage/Template:Angiotensin receptor modulators"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Angiotensin_receptor_modulators469" style="font-size:114%;margin:0 4em"><a href="/wiki/Angiotensin_receptor" class="mw-redirect" title="Angiotensin receptor">Angiotensin receptor</a> <a href="/wiki/Receptor_modulator" title="Receptor modulator">modulators</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Angiotensin_receptor" class="mw-redirect" title="Angiotensin receptor"><abbr title="Angiotensin receptor">ATR</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Angiotensin receptor</span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i>Agonists:</i> <a href="/wiki/Angiotensin_II" class="mw-redirect" title="Angiotensin II">Angiotensin II</a></li> <li><a href="/wiki/Angiotensin_III" class="mw-redirect" title="Angiotensin III">Angiotensin III</a></li> <li><a href="/wiki/Angiotensin_IV" class="mw-redirect" title="Angiotensin IV">Angiotensin IV</a></li> <li><a href="/wiki/L-163,491" title="L-163,491">L-163,491</a></li> <li><a href="/wiki/Saralasin" title="Saralasin">Saralasin</a></li></ul> <ul><li><i>Antagonists:</i> <a href="/wiki/Abitesartan" title="Abitesartan">Abitesartan</a></li> <li><a href="/wiki/Azilsartan" title="Azilsartan">Azilsartan</a></li> <li><a href="/wiki/Candesartan" title="Candesartan">Candesartan</a></li> <li><a href="/w/index.php?title=Elisartan&action=edit&redlink=1" class="new" title="Elisartan (page does not exist)">Elisartan</a></li> <li><a href="/w/index.php?title=Embusartan&action=edit&redlink=1" class="new" title="Embusartan (page does not exist)">Embusartan</a></li> <li><a href="/wiki/Eprosartan" title="Eprosartan">Eprosartan</a></li> <li><a href="/w/index.php?title=EXP-3174&action=edit&redlink=1" class="new" title="EXP-3174 (page does not exist)">EXP-3174</a></li> <li><a href="/wiki/Fimasartan" title="Fimasartan">Fimasartan</a></li> <li><a href="/wiki/Forasartan" title="Forasartan">Forasartan</a></li> <li><a href="/wiki/Irbesartan" title="Irbesartan">Irbesartan</a></li> <li><a href="/wiki/Losartan" title="Losartan">Losartan</a></li> <li><a href="/w/index.php?title=Milfasartan&action=edit&redlink=1" class="new" title="Milfasartan (page does not exist)">Milfasartan</a></li> <li><a href="/wiki/Olmesartan" title="Olmesartan">Olmesartan</a></li> <li><a href="/w/index.php?title=Olodanrigan&action=edit&redlink=1" class="new" title="Olodanrigan (page does not exist)">Olodanrigan</a></li> <li><a href="/w/index.php?title=PD123319&action=edit&redlink=1" class="new" title="PD123319 (page does not exist)">PD123319</a></li> <li><a href="/w/index.php?title=Pomisartan&action=edit&redlink=1" class="new" title="Pomisartan (page does not exist)">Pomisartan</a></li> <li><a href="/w/index.php?title=Pratosartan&action=edit&redlink=1" class="new" title="Pratosartan (page does not exist)">Pratosartan</a></li> <li><a href="/w/index.php?title=Ripisartan&action=edit&redlink=1" class="new" title="Ripisartan (page does not exist)">Ripisartan</a></li> <li><a href="/w/index.php?title=Saprisartan&action=edit&redlink=1" class="new" title="Saprisartan (page does not exist)">Saprisartan</a></li> <li><a href="/wiki/Sparsentan" title="Sparsentan">Sparsentan</a></li> <li><a href="/wiki/Tasosartan" title="Tasosartan">Tasosartan</a></li> <li><a href="/wiki/Telmisartan" title="Telmisartan">Telmisartan</a></li> <li><a href="/wiki/Valsartan" title="Valsartan">Valsartan</a></li> <li><a href="/w/index.php?title=Zolasartan&action=edit&redlink=1" class="new" title="Zolasartan (page does not exist)">Zolasartan</a></li></ul> <ul><li><i><abbr title="Angiotensin-converting-enzyme">ACE</abbr> inhibitors:</i> <a href="/wiki/Alacepril" title="Alacepril">Alacepril</a></li> <li><a href="/wiki/Benazepril" title="Benazepril">Benazepril</a></li> <li><a href="/wiki/Captopril" title="Captopril">Captopril</a></li> <li><a href="/wiki/Cilazapril" title="Cilazapril">Cilazapril</a></li> <li><a href="/wiki/Delapril" title="Delapril">Delapril</a></li> <li><a href="/wiki/Enalapril" title="Enalapril">Enalapril</a></li> <li><a href="/wiki/Enalaprilat" title="Enalaprilat">Enalaprilat</a></li> <li><a href="/wiki/Fosinopril" title="Fosinopril">Fosinopril</a></li> <li><a href="/wiki/Gemopatrilat" title="Gemopatrilat">Gemopatrilat</a></li> <li><a href="/wiki/Imidapril" title="Imidapril">Imidapril</a></li> <li><a href="/wiki/Lisinopril" title="Lisinopril">Lisinopril</a></li> <li><a href="/wiki/Moexipril" title="Moexipril">Moexipril</a></li> <li><a href="/wiki/Omapatrilat" title="Omapatrilat">Omapatrilat</a></li> <li><a href="/wiki/Perindopril" title="Perindopril">Perindopril</a></li> <li><a href="/wiki/Quinapril" title="Quinapril">Quinapril</a></li> <li><a href="/wiki/Quinaprilat" title="Quinaprilat">Quinaprilat</a></li> <li><a href="/wiki/Ramipril" title="Ramipril">Ramipril</a></li> <li><a href="/wiki/Rentiapril" title="Rentiapril">Rentiapril</a></li> <li><a href="/wiki/Rescinnamine" title="Rescinnamine">Rescinnamine</a></li> <li><a href="/wiki/Spirapril" title="Spirapril">Spirapril</a></li> <li><a href="/wiki/Spiraprilat" title="Spiraprilat">Spiraprilat</a></li> <li><a href="/wiki/Temocapril" title="Temocapril">Temocapril</a></li> <li><a href="/wiki/Trandolapril" title="Trandolapril">Trandolapril</a></li> <li><a href="/wiki/Zofenopril" title="Zofenopril">Zofenopril</a></li> <li><a href="/wiki/Zofenoprilat" title="Zofenoprilat">Zofenoprilat</a></li></ul> <ul><li><i>Renin inhibitors:</i> <a href="/wiki/Aliskiren" title="Aliskiren">Aliskiren</a></li> <li><a href="/w/index.php?title=Ciprokiren&action=edit&redlink=1" class="new" title="Ciprokiren (page does not exist)">Ciprokiren</a></li> <li><a href="/w/index.php?title=Ditekiren&action=edit&redlink=1" class="new" title="Ditekiren (page does not exist)">Ditekiren</a></li> <li><a href="/w/index.php?title=Enalkiren&action=edit&redlink=1" class="new" title="Enalkiren (page does not exist)">Enalkiren</a></li> <li><a href="/w/index.php?title=Imarikiren&action=edit&redlink=1" class="new" title="Imarikiren (page does not exist)">Imarikiren</a></li> <li><a href="/wiki/Pepstatin" title="Pepstatin">Pepstatin</a></li> <li><a href="/wiki/Remikiren" title="Remikiren">Remikiren</a></li> <li><a href="/w/index.php?title=Terlakiren&action=edit&redlink=1" class="new" title="Terlakiren (page does not exist)">Terlakiren</a></li> <li><a href="/w/index.php?title=Zankiren&action=edit&redlink=1" class="new" title="Zankiren (page does not exist)">Zankiren</a></li></ul> <ul><li><i>Propeptides:</i> <a href="/wiki/Angiotensinogen" class="mw-redirect" title="Angiotensinogen">Angiotensinogen</a></li> <li><a href="/wiki/Angiotensin_I" class="mw-redirect" title="Angiotensin I">Angiotensin I</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><i>Combinations:</i></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Amlodipine/valsartan" title="Amlodipine/valsartan">Amlodipine/valsartan</a></li> <li><a href="/wiki/Olmesartan/amlodipine" class="mw-redirect" title="Olmesartan/amlodipine">Olmesartan/amlodipine</a></li> <li><a href="/wiki/Olmesartan/amlodipine/hydrochlorothiazide" title="Olmesartan/amlodipine/hydrochlorothiazide">Olmesartan/amlodipine/hydrochlorothiazide</a></li> <li><a href="/wiki/Valsartan/hydrochlorothiazide" title="Valsartan/hydrochlorothiazide">Valsartan/hydrochlorothiazide</a></li> <li><a href="/wiki/Valsartan/hydrochlorothiazide/amlodipine" class="mw-redirect" title="Valsartan/hydrochlorothiazide/amlodipine">Valsartan/hydrochlorothiazide/amlodipine</a></li></ul> </div></td></tr></tbody></table></div>    </div><noscript><img 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