Rilmenidine: A clinical overview

Rilmenidine is an antihypertensive agent with selectivity for I-1 imidazoli ne receptors that acts both centrally by reducing sympathetic overactivity and in the kidney by inhibiting the Na+/H+ antiport. Rilmenidine provides antihypertensive efficacy comparable with that of diur etics, beta-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors. Experience from trials and clinical practice highlights rilmenidine's clini cal and metabolic acceptability in hypertensive populations, including thos e at special risk because of old age, renal impairment, diabetes mellitus, or dyslipidemia. In the at-risk hypertensive, rilmenidine reduces left ventricular hypertrop hy to a similar degree to other reference agents. New studies show a signif icant improvement in glucose metabolism in metabolic syndrome patients trea ted with rilmenidine, and a significant reduction in microalbuminuria durin g rilmenidine treatment of hypertensive type 2 diabetics. Thus the efficacy/tolerance ratio of rilmenidine supports its role as a fir st-line antihypertensive option for all groups of hypertensive patient, wit h specific advantages in some at-risk populations. (C) 2000 American Journa l of Hypertension, Ltd.