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What’s Next? of Aldosterone and Treatment-Resistant Hypertension
Among the new therapeutic agents that target the renin–angiotensin–aldosterone system in patients with treatment-resistant hypertension are nonsteroidal mineralocorticoid receptor antagonists and [antisense oligonucleotide. opens in new tab][17] or [small interfering RNA therapies. opens in new tab][18]. Nonsteroidal mineralocorticoid receptor antagonists such as finerenone and esaxerenone have a longer plasma half-life than spironolactone and are specific for the mineralocorticoid receptor, with no evident hormonal side effects.6 Antisense oligonucleotides and RNA-interference oligonucleotides that are designed to target the synthesis of angiotensinogen in the liver are under investigation in patients with treatment-resistant hypertension.6
Inhibition of aldosterone synthesis with baxdrostat may expand the possible choices of therapeutic agents for treatment-resistant hypertension. The benefits of inhibiting aldosterone synthesis may also extend beyond treatment-resistant hypertension, because elevated levels of aldosterone have been implicated in the pathobiology of pulmonary hypertension, obesity, and insulin resistance and metabolic syndrome.