Golongan Obat Baru dalam Penatalaksanaan Hipertensi

Oleh :

dr.Eduward Thendiono, SpPD,FINASIM

Beberapa obat yang baru ditemukan dan berpotensi untuk digunakan dalam tata laksana hipertensi antara lain dual angiotensin receptor-neprilysin inhibitor, soluble guanylate cyclase stimulator, nonsteroidal dihydropyridine-based mineralocorticoid receptor antagonist, centrally acting aminopeptidase A inhibitor, endothelin receptor antagonist, dan sodium-glucose cotransporter 2 inhibitor.[1]

Hipertensi mempengaruhi sepertiga dari populasi orang dewasa dan sudah diketahui berperan sebagai faktor risiko berbagai penyakit lain seperti infark miokard, gagal jantung, dan stroke.[2,3] Terlepas dari ketersediaan golongan obat antihipertensi yang sudah ada, kasus hipertensi masih sulit terkontrol di seluruh dunia, bahkan prevalensinya semakin meningkat.[4] Oleh karena itu pengembangan obat-obat antihipertensi baru terus dilakukan untuk mengatasi masalah ini.

Dual Angiotensin Receptor-Neprilysin Inhibitor

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. Azizi M, Rossignol P, Hulot JS. Emerging Drug Classes and Their Potential Use in Hypertension. Hypertension. 2019;74:1075-1083. DOI: 10.1161 /HYPERTENSIONAHA.119.12676
2. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet.2016;388:1659–1724. doi:10.1016/S0140-6736(16)31679-8
3. Williams B, et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–3104. doi: 10.1093/ eurheartj/ehy339
4. Beaney T et al. May Measurement Month 2017: an analysis of blood pressure screening results worldwide. Lancet Glob Health. 2018;6:e736–e743.
5. Kario K. The sacubitril/valsartan, a first-in-class, Angiotensin Receptor Neprilysin Inhibitor (ARNI): potential uses in hypertension, heart failure, and beyond. Curr Cardiol Rep.2018;20:5.doi: 10.1007/s11886-018-0944-4
6. Nielsen PM, Grimm D, Wehland M, Simonsen U, Krüger M. The combination of valsartan and sacubitril in the treatment of hypertension and heart failure - an update. Basic Clin Pharmacol Toxicol. 2018;122:9–18. doi: 10.1111/bcpt.12912
7. Zhao Y, Yu H, Zhao X, Ma R, Li N, Yu J. The effects of LCZ696 in patients with hypertension compared with angiotensin receptor blockers: a meta-analysis of randomized controlled trials. J Cardiovasc Pharmacol Ther. 2017;22:447–457. doi: 10.1177/1074248417693379
8. McMurray JJ, et al. PARADIGM-HF Investigators and Committees. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014;371:993–1004. doi: 10.1056/NEJMoa1409077.
9. Solomon SD, et al. Prospective comparison of ARNI with ARB on Management Of heart failure with preserved ejection fraction (PARAMOUNT) Investigators. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet. 2012;380:1387–95. doi: 10.1016/S0140-6736(12)61227-6
10. Sandner P. From molecules to patients: exploring the therapeutic role of soluble guanylate cyclase stimulators. Biol Chem. 2018;399:679–690.doi: 10.1515/hsz-2018-0155.
11. Pieske B et al. Vericiguat in patients with worsening chronic heart failure and preserved ejection fraction: results of the soluble guanylate cyclase stimulator in heart failure patients with PRESERVED EF (SOCRATES-PRESERVED) study. Eur Heart J. 2017;38:1119–1127. doi: 10.1093/eurheartj/ehw593
12. Pitt Bet al. Safety and tolerability of the novel non-steroidal mineralocorticoid receptor antagonist BAY 94-8862 in patients with chronic heart failure and mild or moderate chronic kidney disease: a randomized, double-blind trial. Eur Heart J. 2013;34:2453– 2463. doi: 10.1093/eurheartj/eht187
13. Bakris Glet al. Mineralocorticoid Receptor Antagonist Tolerability Study–Diabetic Nephropathy (ARTS-DN) Study Group. Effect of finerenone on albuminuria in patients with diabetic nephropathy: a randomized clinical trial. JAMA. 2015;314:884–894. doi: 10.1001/jama.2015.10081
14. Marc Y, Llorens-Cortes C. The role of the brain renin-angiotensin system in hypertension: implications for new treatment. Prog Neurobiol. 2011;95:89–103. doi: 10.1016/j.pneurobio.2011.06.006
15. Marc Y, et al. Central antihypertensive effects of orally active aminopeptidase A inhibitors in spontaneously hypertensive rats. Hypertension. 2012;60:411–418. doi: 10.1161/HYPERTENSIONAHA.112.190942
16. Ferdinand KC, Balavoine F, Besse B, Black HR, Desbrandes S, Dittrich HC, Nesbitt SD. Efficacy and safety of firibastat, a first-inclass brain aminopeptidase a inhibitor, in hypertensive overweight patients of multiple ethnic origins. A phase 2, open-label, multicenter, dose-titrating study. 040070 Circulation. 2019;140:138–146. doi: 10.1161/CIRCULATIONAHA.119.
17. Dhaun N, Webb DJ. Endothelins in cardiovascular biology and therapeutics. Nat Rev Cardiol. 2019;16:491–502. doi: 10.1038/s41569-019-0176-3
18. Burnier M. Update on endothelin receptor antagonists in hypertension. Curr Hypertens Rep. 2018;20:51. doi: 10.1007/s11906-018-0848-0
19. Wei A, et al. Clinical adverse effects of endothelin receptor antagonists: insights from the meta-analysis of 4894 patients from 24 randomized double-blind placebo-controlled clinical trials. J Am Heart Assoc. 2016;5:e003896
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