Eddison Chung Hung Chai, Kocherry Cyril, George Jacob
Molecular and Clinical Medicine, University of Dundee Medical School Dundee, Scotland, UK.
J Hypertens. 2025 Aug 1;43(8):1286-1295. doi: 10.1097/HJH.0000000000004055. Epub 2025 May 14.
This review aims to evaluate the impact of novel aldosterone synthase inhibitors, the first new class of antihypertensives in more than 20 years, on the management of resistant hypertension. We highlight the problem of resistant hypertension in clinical practice and describe the challenging history and development of aldosterone synthase inhibitors. The review highlights clinical trial evidence to-date for all agents in this class, with a key focus on the two most mature agents baxdrostat and lorundrostat which are currently in pivotal Phase 3 trials. Both agents have demonstrated significant dose-dependent reductions in blood pressure, particularly in patients with resistant hypertension and crucially, with a minimal impact on cortisol levels. They have also shown promise with marked blood pressure reductions in patients with varying physiological profiles and few adverse events at optimised doses. However, as would be expected, both drugs are associated with increases in serum potassium levels, necessitating careful monitoring.
本综述旨在评估新型醛固酮合酶抑制剂（这是20多年来首个新型抗高血压药物类别）对难治性高血压管理的影响。我们强调了临床实践中难治性高血压的问题，并描述了醛固酮合酶抑制剂具有挑战性的研发历程。本综述重点介绍了该类别所有药物迄今为止的临床试验证据，主要聚焦于两种最成熟的药物巴多司他和洛伦司他，它们目前正处于关键的3期试验阶段。这两种药物均已证明可显著降低血压，且呈剂量依赖性，尤其是在难治性高血压患者中，关键的是，它们对皮质醇水平影响极小。在不同生理特征的患者中，这两种药物在优化剂量下也显示出显著的血压降低效果且不良事件较少。然而，不出所料，这两种药物均与血清钾水平升高有关，因此需要仔细监测。
