Academic Journal
Aldosterone synthase inhibitors may alter how primary care treats hypertension.
| Τίτλος: | Aldosterone synthase inhibitors may alter how primary care treats hypertension. |
|---|---|
| Συγγραφείς: | Lin PJ; Canadian Heart Research Centre, 398 Steeles Avenue West, Units #11-14, Thornhill, Ontario, L4J 6X3, Canada. |
| Πηγή: | American journal of hypertension [Am J Hypertens] 2026 Oct 01; Vol. 39 (Supplement_1), pp. S43-S48. |
| 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): | Hypertension*/drug therapy , Hypertension*/physiopathology , Hypertension*/diagnosis , Cytochrome P-450 CYP11B2*/antagonists & inhibitors , Cytochrome P-450 CYP11B2*/metabolism , Hyperaldosteronism*/drug therapy , Hyperaldosteronism*/diagnosis , Antihypertensive Agents*/therapeutic use , Blood Pressure*/drug effects , Enzyme Inhibitors*/therapeutic use , Primary Health Care*, Aldosterone/blood ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Humans ; Treatment Outcome |
| Περίληψη: | Hypertension guidelines recommend adding antihypertensive therapies until the blood pressure (BP) is below a specific target. If the BP is not below target with 3 medications, including a diuretic, then it is labeled resistant hypertension, and then we investigate for secondary causes, such as primary aldosteronism (PA). PA testing seems complex with 3 results: aldosterone, renin, and the aldosterone-renin ratio. Hence, these tests are ordered infrequently, and the diagnosis of PA is often delayed or never made. Also, heart failure, chronic kidney disease, and other conditions can have elevated aldosterone, which are not PA-related. The traditional treatment with aldosterone receptor blockers/mineralocorticoid receptor antagonists has been helpful, but they block the effects that are mediated through the mineralocorticoid receptor. The non-receptor effects of high aldosterone may continue to cause harm. Therefore, blocking the production of aldosterone with an aldosterone synthase inhibitor (ASI) could be a more complete strategy to address elevated aldosterone levels. In addition, an "ASI Challenge" may help us decide which patients need formal testing for PA. If the systolic blood pressure drops a significant amount (>10 mm Hg), then that suggests aldosterone is a key component of the uncontrolled BP, and those patients should be considered for formal PA testing. For those who drop a modest amount (<10 mm Hg), they would be less likely to need PA testing. Such an approach could use an ASI agent as a diagnostic/screening tool as well as a therapeutic agent, which would be very helpful in the primary care setting. (© 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; blood pressure; hypertension; primary care; resistant hypertension |
| Substance Nomenclature: | EC 1.14.15.4 (Cytochrome P-450 CYP11B2) 0 (Antihypertensive Agents) 4964P6T9RB (Aldosterone) 0 (Mineralocorticoid Receptor Antagonists) 0 (Enzyme Inhibitors) |
| Entry Date(s): | Date Created: 20261008 Date Completed: 20261008 Latest Revision: 20261008 |
| Update Code: | 20261009 |
| DOI: | 10.1093/ajh/hpag093 |
| PMID: | 42847228 |
| Βάση Δεδομένων: | MEDLINE |
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