Academic Journal
From low renin to the primary aldosteronism spectrum: aldosterone synthase inhibitors and the endocrine management of hypertension.
| Τίτλος: | From low renin to the primary aldosteronism spectrum: aldosterone synthase inhibitors and the endocrine management of hypertension. |
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| Συγγραφείς: | Kline GA; Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. |
| Πηγή: | American journal of hypertension [Am J Hypertens] 2026 Oct 01; Vol. 39 (Supplement_1), pp. S66-S77. |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Oxford University Press Country of Publication: United States NLM ID: 8803676 Publication Model: Print Cited Medium: Internet ISSN: 1941-7225 (Electronic) Linking ISSN: 08957061 NLM ISO Abbreviation: Am J Hypertens Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2013- : Oxford : Oxford University Press Original Publication: [New York, NY] : Elsevier, [c1988- |
| Ιατρικοί όροι (MeSH): | Hyperaldosteronism*/drug therapy , Hyperaldosteronism*/blood , Hyperaldosteronism*/physiopathology , Hyperaldosteronism*/diagnosis , Hyperaldosteronism*/complications , Hypertension*/drug therapy , Hypertension*/physiopathology , Hypertension*/etiology , Hypertension*/blood , Cytochrome P-450 CYP11B2*/antagonists & inhibitors , Cytochrome P-450 CYP11B2*/metabolism , Renin*/blood , Antihypertensive Agents*/therapeutic use , Antihypertensive Agents*/adverse effects , Blood Pressure*/drug effects , Enzyme Inhibitors*/therapeutic use, Mineralocorticoid Receptor Antagonists/therapeutic use ; Aldosterone/blood ; Renin-Angiotensin System/drug effects ; Humans ; Treatment Outcome ; Animals |
| Περίληψη: | Background: Hypertension remains a major contributor to global cardiovascular morbidity despite decades of available therapy. Aim: This review advances an endocrinological framework in which chronic hypertension, including resistant hypertension, is understood as a consequence of dysregulated hormonal control of renal sodium handling, mediated by excess renin-angiotensin II activity, inappropriate aldosterone excess, or both. Results: Within this framework, the traditional binary distinction between "essential" and "secondary" hypertension gives way to a mechanistic continuum characterized by biochemical phenotyping using renin and aldosterone. Primary aldosteronism (PA) is now recognized as existing across a spectrum of severity that is broader than classical diagnostic thresholds suggest, and aldosterone dysregulation, even at subclinical levels, confers adverse cardiorenal outcomes exceeding those of renin-dependent hypertension. Mineralocorticoid receptor antagonists (MRAs) are effective when aldosterone excess is the dominant mechanism but do not correct the underlying endocrinopathy and may be limited by tolerability at the doses required to achieve full biochemical targets. Highly selective second-generation aldosterone synthase inhibitors (ASIs), including baxdrostat and lorundrostat, directly suppress aldosterone production, mirror the biochemical response seen after surgical adrenalectomy, and may confer disease-modifying effects beyond blood pressure reduction. Conclusion: Integrated into a mechanism-first clinical algorithm driven by renin and aldosterone profiling, ASIs and MRAs offer the potential to transform management of low-renin and PA-spectrum hypertension, moving clinicians from empirical, add-on drug strategies toward individualized, pathophysiology-guided care. (© The Author(s) 2026. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.) |
| Contributed Indexing: | Keywords: aldosterone synthase inhibitors; blood pressure; endocrine hypertension; hypertension; primary aldosteronism |
| Substance Nomenclature: | EC 1.14.15.4 (Cytochrome P-450 CYP11B2) EC 3.4.23.15 (Renin) 0 (Mineralocorticoid Receptor Antagonists) 0 (Antihypertensive Agents) 4964P6T9RB (Aldosterone) 0 (Enzyme Inhibitors) |
| Entry Date(s): | Date Created: 20261008 Date Completed: 20261008 Latest Revision: 20261008 |
| Update Code: | 20261009 |
| DOI: | 10.1093/ajh/hpag078 |
| PMID: | 42847227 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1941-7225 |
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| DOI: | 10.1093/ajh/hpag078 |