There is now clear evidence that reducing blood pressure (BP) with a broad range 
of agents, including angiotensin converting enzyme inhibitors and angiotensin 
receptor blockers, improves cardiovascular and renal outcomes. There is also 
evidence suggesting that these drugs have beneficial effects that are 
independent of BP lowering. Aliskiren is a direct renin inhibitor that 
interrupts the renin-angiotensin-aldosterone system (RAAS) at its rate-limiting 
step. Unlike angiotensin-converting enzyme inhibitors and angiotensin receptor 
blockers, aliskiren produces a sustained reduction in plasma renin activity and 
reduces plasma levels of angiotensin II and aldosterone. Preclinical data and 
clinical trials in high-risk patients using surrogate markers increasingly 
suggest that aliskiren can reduce the progression of end-organ damage beyond 
that afforded by BP control. With its unique mechanism of action, combining 
aliskiren with another RAAS-blocking agent that has a different mechanism of 
action may provide more comprehensive blockade of the RAAS, potentially 
conferring additional clinical benefits. Evaluation of these end-organ effects 
in humans is underway in clinical trials designed to assess the effects of 
aliskiren alone and in combination with other antihypertensive agents on 
cardiovascular and renal outcomes.