The challenge of introducing aldosterone synthase inhibitors into multidisciplinary practice

Novel therapeutic agents are required to improve hypertension control globally, which remains one of the leading modifiable risk factors for premature cardiovascular mortality. Aldosterone synthase inhibitors (ASIs) are a novel class of agents that suppress aldosterone production and have demonstrated clinically meaningful blood pressure reductions in phase 2 and phase 3 trials in patients with uncontrolled and resistant hypertension. As these therapies approach clinical adoption, important questions remain regarding effects on cardiovascular and kidney outcomes, safety profile, and optimal positioning within existing treatment algorithms. This review synthesizes the current clinical evidence for ASIs, highlights key knowledge gaps, and examines practical considerations for their real-world implementation, including persistent pharmacodynamic effects after treatment withdrawal, short-term changes in glomerular filtration rate, the risk of hyperkalemia, and the potential role of multidisciplinary care models to support safe and effective adoption.