| Objective: The excessive activation of systemic and local renin–angiotensin–system (RAS) has a very close contact with the occurrence and development of essential hypertension. AngiotensinⅡ(AngⅡ) sits in the core position of RAS, and its hemodynamic and non-hemodynamic effects play important roles in the occurrence and development of hypertension and renal complications. The early renal damage of hypertension could not be detected by the routine blood and urine inspection. Cystatin-C (Cys-C) is considered a sensitive marker in the evaluation of early renal damage in recent years.For the purpose of reduction hypertension and renal damage mediated by AngⅡ, in recent years the method of RAS inhibition became a research hotspot. Renin inhibitor Aliskiren affects on the first rate-limiting step in RAS. It can reduce the plasma renin activity(PRA), which is different from ACEI and ARB.Thus, by observing the effects of 50, 150, 300mg Aliskiren on plasma AngⅡ, blood pressure and serum Cys-C levels, and comparing with the effect of 5mg ramipril, this study explored the degree of RAS inhibition, antihypertensive effect and renal protective effect of Aliskiren in patients with essential hypertension.Methods: We chose mild-moderate essential hypertension patients in the Second Hospital of Hebei Medical University cardiovascular medicine outpatient from October 2007 to November 2008. The patients must meet all the inclusion criteria and no exclusion criteria, then they were randomized to aliskiren 75, 150, 300mg or Ramipril 5mg once daily for 8 weeks. Before and after treatment they were measured demographic indicators and sitting blood pressure for three times, and were collected cubital vein blood samples. RIA used in the determination of plasma AngⅡlevels, ELISA method for measuring serum Cys-C levels.Statistical analysis of data was performed by the SPSS13.0 statistical software pack for Windows. Measurement data were expressed as mean±standard deviation (±s). Paired t-test was used to comparison inside group; Analysis of variance (ANOVA) was used to comparison between groups. P<0.05 is deemed to have statistical significance.Results: There were 78 patients who completed the trial. Aliskiren 300mg group: 20 cases, Aliskiren 150mg group: 20 cases, Aliskiren 75mg group: 18 cases, Ramipril 5mg group: 20 cases. There was no significant difference among the four groups of age, height, weight, WC, HC, FBG and blood lipids(P>0.05).1. Before treatment the levels of AngⅡin group Aliskiren 300mg, 150mg, 5mg and Ramipril 5mg were 134.17±31.37pg/ ml, 131.20±31.78pg/ml, 133.16±32.89pg/ml and 134.94±32.02 pg/ml,and there was no significantly difference among them (P>0.05). After treatment the numbers were 78.05±10.84 pg/ml, 89.89±12.39pg/ml, 94.65±10.57pg/ml, 92.97±12.41pg/ml. The numbers were lower than those before (P<0.05). And the AngⅡlevel were different among the four groups (P<0.05). The three groups of Aliskiren were further compared with the control group Ramipril 5mg separately, which shows that the AngⅡlevel of Aliskiren 300mg was lower than that of Ramipril 5mg (P<0.05); AngⅡlevel of Aliskiren 75mg was higher than that of Ramipril 5mg(P<0.05); There was no significantly difference between Aliskiren 150mg and Ramipril 5mg(P>0.05).2. Before treatment there was no significantly difference among BPs of the four groups(P>0.05). After treatment the BPs of all the four groups significantly decreased. The msSBP before and after treatment were: Group Aliskiren 300mg: 146.82±10.46 vs.130.90±8.37mmHg (P<0.05), Group Aliskiren 150mg:146.17±9.29 vs.133.18±10.13mmHg(P<0.05), Group Aliskiren 75mg:143.20±9.84 vs. 135.89±10.72mmHg(P<0.05), Group Ramipril 5mg:145.59±5.46 vs.134.23±8.46mmHg(P< 0.05). The msDBP were: 98.52±5.62 vs.83.75±6.86mmHg(P< 0.05),99.68±5.03 vs.88.91±4.25mmHg(P<0.05),98.43±4.61 vs.92.65±4.63mmHg(P<0.05),98.98±4.99 vs.88.23±4.66mmHg (P<0.05). And the msDBP were different among the four groups after treatment(P<0.05). The three groups of Aliskiren were further compared with the control group Ramipril 5mg separately, which shows that the msDBP of Aliskiren 300mg was lower than that of Ramipril 5mg (P<0.05); The msDBP of Aliskiren 75mg was higher than that of Ramipril 5mg (P<0.05); There was no significantly difference between Aliskiren 150mg and Ramipril 5mg(P>0.05). The msSBP also showed the same trend as msDBP, but the difference failed to achieve statistically significant.3. Before treatment the levels of Cys-C in the four groups were 1.612±0.293mg/L, 1.589±0.291mg/L, 1.627±0.324 mg/L, 1.606±0.291mg/L , and there was no significantly difference among them(P>0.05). After treatment the numbers were 1.463±0.242mg/L, 1.546±0.256mg/L, 1.580±0.335 mg/L, 1.580±0.252 mg/L. There were declining trend in all the four groups. But the reductions of group Aliskiren150mg, 75mg and Ramipril 5mg fail to achieve statistically significant (P>0.05); The number of group Aliskiren 300mg significantly decreased, with statistical significance(P<0.05).Conclusion: 1. Aliskiren 75mg, 150mg and 300mg can all reduce the plasma AngⅡlevels and blood pressure, and the effect enhanced with the dose increased. The effect of Ramipril 5mg is same as Aliskiren 75mg.2. Aliskiren 300mg can decrease serum Cys-C, has an obvious protective effect of the kidney.
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