Now how about direct renin inhibitors?
Stop for a minute and think back to that flow chart, which part of the flowchart -
beginning, middle, or end - do direct inhibitors get involved?
Obviously, it’s the first, right, because the RAAS start with renin.
So if we can inhibit renin, we're gonna have a huge impact on the patient’s blood pressure.
If you inhibit renin, you suppress the RAAS from step one.
So what are the adverse effects? There’s our friend the red box to talk to us.
They have less cough and angioedema than ACE inhibitors but they may still develop it.
They should not be used in pregnancy either, so shouldn't use ACE inhibitors,
you shouldn't use ARBs, and you shouldn’t use DRIs in pregnancy.
Hyperkalemia maybe a problem especially if you use it with a ACE inhibitors, so watch that carefully.
That’s not a great combination.
Now that brings up a really good point, that patients are often not just on one blood pressure medication.
I know at one point, when my weight was not under control, I was on five different kinds of blood pressure medications -
so thankfully I don’t have to be on those now, but over the history you're gonna see patients all the time
that are on multiple medications, maybe even more than I was on.
So keep that in mind, we use medications that come out with different mechanisms
and that’s how we used to treat blood pressure that is really hard to control.
But I promise you, I'm a living example that lifestyle really does impact your level of hypertension.
So if you can maintain a healthy weight for your body and cardiovascular fitness,
you're gonna really help your patients control their blood pressure.