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<p>Despite the availability of numerous antihypertensive agents, blood pressure control remains inadequate. Treatment resistance, poor adherence, adverse effects and limited impact on end-organ damage pose core challenges. Novel targeted agents offer promising approaches. Aldosterone synthase inhibitors, such as baxdrostat and lorundrostat directly inhibit aldosterone production and have demonstrated substantial blood pressure reduction with good tolerability in clinical studies. As causal treatment they may even qualify as first-line options, particularly in obesity-related hypertension. Angiotensinogen blockers, such as the small interfering RNA (siRNA) zilebesiran aim to prevent escape of the renin-angiotensin-aldosterone (RAAS) system by inhibiting hepatic angiotensinogen synthesis. The innovative subcutaneous biannual administration strengthens patient adherence. Antisense oligonucleotides, such as evazarsen also show potential but are still at an earlier developmental stage. Glucagon-like peptide 1 (GLP-1) receptor agonists not only promote weight loss but also lower blood pressure via inhibition of the sympathetic nervous system, vasodilation and natriuresis, thereby providing a&#xa0;dual approach. Endothelin receptor antagonists, such as aprocitentan effectively reduce blood pressure in resistant hypertension and can attenuate end-organ damage through anti-inflammatory and antifibrotic effects. These emerging drug classes could enable more effective, causal and individualized hypertension management in the future; however, phase&#xa0;III data and cost-effectiveness analyses are still largely pending.</p>

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Neue Antihypertensiva – was liegt vor uns?

  • 期刊论文

  • 发表日期：

    2025年8月18日

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  • Milen Babic,
  • Markus van der Giet

摘要

Despite the availability of numerous antihypertensive agents, blood pressure control remains inadequate. Treatment resistance, poor adherence, adverse effects and limited impact on end-organ damage pose core challenges. Novel targeted agents offer promising approaches. Aldosterone synthase inhibitors, such as baxdrostat and lorundrostat directly inhibit aldosterone production and have demonstrated substantial blood pressure reduction with good tolerability in clinical studies. As causal treatment they may even qualify as first-line options, particularly in obesity-related hypertension. Angiotensinogen blockers, such as the small interfering RNA (siRNA) zilebesiran aim to prevent escape of the renin-angiotensin-aldosterone (RAAS) system by inhibiting hepatic angiotensinogen synthesis. The innovative subcutaneous biannual administration strengthens patient adherence. Antisense oligonucleotides, such as evazarsen also show potential but are still at an earlier developmental stage. Glucagon-like peptide 1 (GLP-1) receptor agonists not only promote weight loss but also lower blood pressure via inhibition of the sympathetic nervous system, vasodilation and natriuresis, thereby providing a dual approach. Endothelin receptor antagonists, such as aprocitentan effectively reduce blood pressure in resistant hypertension and can attenuate end-organ damage through anti-inflammatory and antifibrotic effects. These emerging drug classes could enable more effective, causal and individualized hypertension management in the future; however, phase III data and cost-effectiveness analyses are still largely pending.