Approach to Resistant Hypertension: A Review of Recent Pharmacological Advances

The goal of this review is to provide an updated perspective on the management of resistant hypertension (RHTN) by evaluating the latest pharmacological advancements.

Recent research has introduced several novel therapies targeting unique mechanisms in blood pressure regulation. These include non-steroidal mineralocorticoid receptor antagonists, dual endothelin receptor antagonists, aldosterone synthase inhibitors, and angiotensinogen synthesis inhibitors. Clinical trials have demonstrated promising results, showing these new treatments offer enhanced efficacy and safety profiles compared to traditional antihypertensive therapies.

The review concludes that these emerging pharmacological treatments represent significant advancements in the management of RHTN, with potential to improve patient outcomes. The findings underscore the need for ongoing research to further validate these therapies and explore their long-term impact on cardiovascular health.

The management of RHTN benefits from a consideration of both traditional therapies and recent pharmacological innovations. Non-steroidal mineralocorticoid receptor antagonists, such as finerenone, appear to offer an improved safety profile, particularly for patients with chronic kidney disease, and may be considered as a valuable addition to treatment regimens. Aprocitentan, a dual endothelin receptor antagonist, has emerged as a potential alternative for patients at risk of hyperkalemia, offering effective blood pressure control while minimizing certain risks associated with first-line anti-hypertensive therapies. Aldosterone synthase inhibitors like baxdrostat show promise, though their use may warrant close monitoring for hyperkalemia, especially in patients with renal impairment. Novel angiotensinogen synthesis inhibitors offer a potential extended dosing that has the potential to address challenges with medication adherence. The integration of these emerging treatments into clinical practice, alongside established therapies, could provide a more effective strategy for managing RHTN.