Update on rilmenidine: Clinical benefits

Rilmenidine is an imidazoline derivative that appears to lower blood pressu re (BP) by an interaction with imidazoline (I-1) receptors in the brainstem (and kidneys). Rilmenidine is as effective in monotherapy as all other fir st-line classes of drugs, including diuretics, beta -blockers, angiotensin converting enzyme (ACE) inhibitors, and calcium antagonists. It is well tol erated and can be taken in combination for greater efficacy. Sedation and d ry mouth are not prominent side effects and withdrawal hypertension is not seen when treatment is stopped abruptly. Recently, in addition to a reduction in BP, this agent has been shown to im prove glucose tolerance, lipid risk factors. and insulin sensitivity. These changes would be consistent with a reduction in long-term cardiovascular r isk, as would recently described actions on the heart (reducing left ventri cular hypertrophy) and the kidney (reducing microalbuminuria). Although no data are yet available from prospective long-term outcome studies, rilmenid ine could represent an important new development in antihypertensive therap y and the prevention of cardiovascular disease. (C) 2001 American Journal o f Hypertension, Ltd.