Aldosterone synthase inhibitors in hypertension and chronic kidney disease: double the benefit?

Aldosterone synthase inhibitors (ASIs) are novel drugs for cardiorenal protection. These compounds block aldosterone production and lower blood levels by targeting its biosynthesis pathway. ASIs induce a complete suppression of both genomic and nongenomic aldosterone effects, while reducing the risks of hyperkalaemia and aldosterone escape. In the present review, we will summarize the clinical potential of current ASIs in hypertension and chronic kidney disease (CKD).

Selective ASIs have been extensively evaluated in patients with both primary and resistant hypertension, and are promising therapeutic agents in CKD. Baxdrostat and lorundrostat effectively lowered blood pressure in patients with resistant or uncontrolled hypertension and showed favourable effects on renal outcomes. In CKD patients, vicadrostat determined a dose-dependent reduction of albuminuria and additive beneficial effects when used on top of empagliflozin.

In randomized controlled trials, patients assigned to second generation ASIs had beneficial effects on blood pressure and albuminuria, with enhanced safety profiles. Although long-term clinical outcomes are still under investigation, ASIs have the potential to narrow critical gaps in cardiorenal care.