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It is a direct renin inhibitor, decreasing plasma renin activity and inhibiting the conversion of angiotensinogen to angiotensin I. ACE-inhibitors can only block the ACE pathway resulting in angiotensin II production via the non-ACE pathway. ARBs also increase the level of angiotensin II through negative feedback mechanism. Aliskiren reduces angiotensin I, angiotensin II, a powerful vasoconstrictor, and aldosterone secretion and sodium reabsorption. It is unknown whether Aliskiren affects ACE or non-ACE pathways. The full antihypertensive effect can be reached by 2 weeks with once-daily dosing in mild-to-moderate hypertension...
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