Emerging therapeutic frontiers in hypertension management

Figures

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  Figure 1. Timeline of antihypertensive drug development from 1950 to 2024, highlighting major therapeutic classes and emerging novel agents, both approved and in phases 1–3 of trials for the treatment of hypertension, including AT2R agonists, nsMRA, and various other novel therapeutic approaches. ACEI, angiotensin-converting enzyme inhibitors; APAIs, aminopeptidase A inhibitors; ASI, aldosterone synthase inhibitors; AT1R, angiotensin II type 1 receptor blockers; AT2R, angiotensin II type 2 receptor agonists; ARNI, angiotensin receptor neprilysin inhibitor; CCB, calcium channel blockers; ERA, endothelin receptor antagonist; GLP1 RAs, glucagon-like peptide 1 receptor agonists; HCZ, hydrochlorothiazide; HTN, hypertension; nsMRA, non-steroidal mineralocorticoid receptor blocker; NPR1 agonists, natriuretic peptide receptor 1 agonists; R, receptor; RAS, renin-angiotensin system; sGC, soluble guanylate cyclase, stimulator; siRNA, small interfering RNA; VAP-1, vascular adhesion protein 1.

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  Figure 2. Schematic representation of the renin-angiotensin-aldosterone and endothelin systems along with their pharmacological targets, illustrating classical and novel therapeutic interventions in hypertension including direct renin inhibitors, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), angiotensin receptor neprilysin inhibitors (ARNI) mineralocorticoid receptor antagonists (MRA), and newer agents targeting various pathways, angiotensinogen silencing via siRNA (small interfering RNA), endothelin receptor antagonists (ERA), natriuretic peptide receptor 1 agonists (NPR1 agonists), aminopeptidase A inhibitors (APAIs), aldosterone synthase inhibitors (ASIs). AT1R, angiotensin II type 1 receptor; AT2R, angiotensin II type 2 receptor; ET R, endothelin receptor; ET, endothelin.