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Hypertension

Inhibiting aldosterone synthase reduces blood pressure

Nature Reviews Cardiology volume 20, page 6 (2023)Cite this article

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Baxdrostat, a selective inhibitor of aldosterone synthase, reduces blood pressure in a dose-dependent manner in patients with treatment-resistant hypertension. Selectively inhibiting aldosterone synthase is challenging because of its similarity to 11β-hydroxylase, which is involved in cortisol synthesis. In previous studies, baxdrostat was shown to have high selectivity for aldosterone synthase and to reduce plasma aldosterone (but not cortisol) levels. In the phase II BrigHTN trial, 248 patients with treatment-resistant hypertension (blood pressure ≥130/80 mmHg and receiving a diuretic and at least two other antihypertensive drugs) were randomly assigned to receive baxdrostat (2.0 mg, 1.0 mg or 0.5 mg) once daily or placebo. After 12 weeks, systolic blood pressure was reduced by 20.3 mmHg, 17.5 mmHg, 12.1 mmHg and 9.4 mmHg in the respective groups. No instances of adrenocortical insufficiency were reported. Selective inhibition of aldosterone synthase might provide an alternative strategy to mineralocorticoid receptor antagonism in patients with treatment-resistant hypertension.

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  1. Nature Reviews Cardiology http://www.nature.com/nrcardio/

    Gregory B. Lim

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  1. Gregory B. Lim
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Correspondence to Gregory B. Lim.

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Lim, G.B. Inhibiting aldosterone synthase reduces blood pressure. Nat Rev Cardiol 20, 6 (2023). https://doi.org/10.1038/s41569-022-00810-w

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