Aldosterone and Treatment-Resistant Hypertension

This editorial discusses the role of aldosterone in treatment resistant hypertension (defined as blood pressure ≥130/80 mm Hg despite three antihypertensive medications, including a diuretic). It highlights the PATHWAY 2 trial’s findings on spironolactone’s efficacy and introduces baxdrostat, a selective aldosterone synthase (CYP11B2) inhibitor that reduces aldosterone without affecting cortisol synthesis. The article underscores the unmet need in hypertension management, as only 24% of patients achieve controlled blood pressure. Emerging therapies, including nonsteroidal mineralocorticoid receptor antagonists (e.g., finerenone) and RNA based therapies targeting angiotensinogen, are also explored. The piece emphasizes the potential of baxdrostat to expand treatment options for resistant hypertension and related conditions like metabolic syndrome.

This editorial discusses the role of aldosterone in treatment resistant hypertension (defined as blood pressure ≥130/80 mm Hg despite three antihypertensive medications, including a diuretic). It highlights the PATHWAY 2 trial’s findings on spironolactone’s efficacy and introduces baxdrostat, a selective aldosterone synthase (CYP11B2) inhibitor that reduces aldosterone without affecting cortisol synthesis. The article underscores the unmet need in hypertension management, as only 24% of patients achieve controlled blood pressure. Emerging therapies, including nonsteroidal mineralocorticoid receptor antagonists (e.g., finerenone) and RNA based therapies targeting angiotensinogen, are also explored. The piece emphasizes the potential of baxdrostat to expand treatment options for resistant hypertension and related conditions like metabolic syndrome.