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Update on Valev® - March, 2002

On March 20, 2002, it was reported (www.reuters.com)that Vanlev (omapatrilat) was not shown to be any better than enalapril and was associated with an allergic reaction called angioedema. These results suggest that Vanlev will not make it to the market, and will not be the first vasopeptidase inhibitor available for general use.

Why are there so many drugs for high blood pressure?

ACE inhibitors, beta-blockers, alpha-blockers, calcium channel blockers, thiazide diuretics, loop diuretics, vasodilators...Why are there so many different kinds of drugs to treat a condition that usually does not even make people feel any different than normal? The answer is that even though a person with high blood pressure (also called hypertension) may not feel like anything is wrong, the constant high pressure in their arteries and veins can cause irreversible damage to the kidneys, eyes, brain, and of course, to the heart. In fact, uncontrolled high blood pressure is the leading cause of stroke and heart attack in the United States. Worldwide, more than 600 million people have high blood pressure, while more than 50 million people in the United States have high blood pressure.

For years, the standard therapy for high blood pressure has been a thiazide diuretic and beta-blocker. ACE inhibitors (ACE stands for angiotensin converting enzyme) have become increasingly popular over the past several years, as they have been shown to be very effective at lowering blood pressure while helping to protect important organs like the kidneys. Currently, a new kind of medication is being studied which combines an ACE inhibitor with an additional blood pressure lowering mechanism. This new class of medication is called the vasopeptidase inhibitors (VPI).

Vasopeptidase Inhibitors - How do they work?

Vasopeptidase inhibitors work in two different ways. First, vasopeptidase inhibitors are themselves ACE inhibitors. This ACE inhibitor component of the vasopeptidase inhibitors causes a decrease in blood vessel constriction, leading to a decrease in blood pressure. Second, vasopeptidase inhibitors are neutral endopeptidase (NEP) inhibitors. Neutral endopeptidase is a chemical responsible for the breakdown of several different chemicals in the body, some of which help to decrease blood pressure. By blocking neutral endopeptidase, there is an increase in the amount of these "good" chemicals that help to lower blood pressure. The two mechanisms of vasopeptidase inhibitors appear to work together in a synergistic manner. This means that the combination of the two mechanisms provides a greater blood pressure lowering effect than would be expected if the effect of each individual mechanism were added together. To think of this in another way, it means that 2 + 2 = 5 rather than 2 + 2 = 4.

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