TY - JOUR
T1 - Taming resistant hypertension
T2 - The promise of novel pharmacologic approaches and renal denervation
AU - Azzam, Omar
AU - Nejad, Sayeh Heidari
AU - Carnagarin, Revathy
AU - Nolde, Janis M.
AU - Galindo-Kiuchi, Marcio
AU - Schlaich, Markus P.
N1 - Publisher Copyright:
© 2023 The Authors. British Journal of Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.
PY - 2024/2
Y1 - 2024/2
N2 - Resistant hypertension is associated with an exceedingly high cardiovascular risk and there remains an unmet therapeutic need driven by pathophysiologic pathways unaddressed by guideline-recommended therapy. While spironolactone is widely considered as the preferable fourth-line drug, its broad application is limited by its side effect profile, especially off-target steroid receptor-mediated effects and hyperkalaemia in at-risk subpopulations. Recent landmark trials have reported promising safety and efficacy results for a number of novel compounds targeting relevant pathophysiologic pathways that remain unopposed by contemporary drugs. These include the dual endothelin receptor antagonist, aprocitentan, the aldosterone synthase inhibitor, baxdrostat and the nonsteroidal mineralocorticoid receptor antagonist finerenone. Furthermore, the evidence base for consideration of catheter-based renal denervation as a safe and effective adjunct therapeutic approach across the clinical spectrum of hypertension has been further substantiated. This review will summarise the recently published evidence on novel antihypertensive drugs and renal denervation in the context of resistant hypertension.
AB - Resistant hypertension is associated with an exceedingly high cardiovascular risk and there remains an unmet therapeutic need driven by pathophysiologic pathways unaddressed by guideline-recommended therapy. While spironolactone is widely considered as the preferable fourth-line drug, its broad application is limited by its side effect profile, especially off-target steroid receptor-mediated effects and hyperkalaemia in at-risk subpopulations. Recent landmark trials have reported promising safety and efficacy results for a number of novel compounds targeting relevant pathophysiologic pathways that remain unopposed by contemporary drugs. These include the dual endothelin receptor antagonist, aprocitentan, the aldosterone synthase inhibitor, baxdrostat and the nonsteroidal mineralocorticoid receptor antagonist finerenone. Furthermore, the evidence base for consideration of catheter-based renal denervation as a safe and effective adjunct therapeutic approach across the clinical spectrum of hypertension has been further substantiated. This review will summarise the recently published evidence on novel antihypertensive drugs and renal denervation in the context of resistant hypertension.
KW - aldosterone synthase inhibitors
KW - endothelin antagonists
KW - pharmacotherapy
KW - renal denervation
KW - resistant hypertension
KW - sympathetic nervous system
UR - http://www.scopus.com/inward/record.url?scp=85174424462&partnerID=8YFLogxK
U2 - 10.1111/bph.16247
DO - 10.1111/bph.16247
M3 - Review article
C2 - 37715452
AN - SCOPUS:85174424462
SN - 0007-1188
VL - 181
SP - 319
EP - 339
JO - British Journal of Pharmacology
JF - British Journal of Pharmacology
IS - 3
ER -