Emerging pharmacological approaches, including non-steroidal mineralocorticoid receptor antagonists, RNA-targeting therapies, GLP-1 RAs, and SGLT2 inhibitors, offer novel strategies to lower blood pressure.
What are the emerging pharmacological approaches for lowering high blood pressure in patients with arterial hypertension?
Emerging pharmacological therapies targeting the RAAS pathway and metabolic risk factors offer promising new strategies for managing uncontrolled and resistant hypertension.
Despite the availability of several drug classes for the treatment of hypertension, the current approaches to high blood pressure (BP) are not fully satisfying the needs of this patient population. As a result, in recent years, many clinical trials have investigated novel pharmacological approaches for lowering high BP. As overactivity of the renin-angiotensin-aldosterone system is often present in hypertensive patients, especially those with resistant hypertension, several studies have focused on novel strategies to counteract this phenomenon by the use of non-steroidal inhibitors of the mineralocorticoid receptors, aldosterone synthase inhibitors or RNA-targeting therapies to inhibit the hepatic synthesis of angiotensinogen. The latter approach in particular might offer the additional advantage of reducing the daily pill burden of these patients, hence mitigating the common occurrence of non-adherence to treatment. Because obesity and diabetes are common risk factors for hypertension (a high percentage of individuals with resistant hypertension being obese), numerous investigations have analyzed the BP-lowering effects of those agents, such as glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors, which have been shown to reduce body weight and improve cardiovascular outcomes in these patients. Available evidence suggests that these drug classes can indeed afford a clinically meaningful BP decrease and, potentially, reduce the treatment burden. In conclusion, even though the rates of uncontrolled hypertension remain high, several novel therapeutic options are in the offing. As these emerging treatments will compound with many already available agents, future efforts should be directed at better phenotyping patients to tailor the most suitable approach for each one.
Schinzari et al. (Tue,) conducted a review in Arterial Hypertension. Novel pharmacological approaches (non-steroidal MRAs, aldosterone synthase inhibitors, RNA-targeting therapies, GLP-1 RAs, SGLT2 inhibitors) was evaluated. Emerging pharmacological approaches, including non-steroidal mineralocorticoid receptor antagonists, RNA-targeting therapies, GLP-1 RAs, and SGLT2 inhibitors, offer novel strategies to lower blood pressure.