Novel pharmacologic approaches in resistant hypertension

Resistant hypertension (RH) affects 10% to 18% of all patients with hypertension. It is diagnosed when blood pressure cannot be normalized despite the use of 3 classes of antihypertensive drugs (ACE inhibitors or sartans), calcium antagonists and diuretics in maximum doses. If the above-mentioned drugs are ineffective, spironolactone is most often administered. Recently, valsartan/sacubitrol and flozins have been increasingly used in resistant hypertension, which have been introduced for the treatment of diseases other than hypertension but can be a supplement to previously used drugs in resistant hypertension. Pharmaceutical companies are currently working on a dozen or so antihypertensive drugs. The most advanced studies concern aldosterone synthesis inhibitors, an endothelin receptor antagonist, and a drug that inhibits angiotensinogen synthesis. The results to date allow for the consideration of aprocitentan (a drug that inhibits endothelin receptors) or baxdrostat or another new aldosterone synthesis inhibitor in the treatment of resistant hypertension that does not respond to 4 drugs, including spironolactone. Further studies are needed to confirm the efficacy and safety of these new drugs in the treatment of resistant hypertension.