Novel approaches in antihypertensive pharmacotherapeutics

Curr Opin Nephrol Hypertens. 2025 Apr 23. doi: 10.1097/MNH.0000000000001081. Online ahead of print.

Abstract

Purpose of review: The management of hypertension remains suboptimal despite the widespread use of multiple antihypertensive medication groups. We hereby aim to evaluate the novel therapeutic approaches for the management of hypertension.

Recent findings: As the decline in SBP and/or DBP is associated with a significant decline in major adverse cardiovascular events and all-cause mortality, the optimal management of hypertension is at most importance. The high prevalence of resistant hypertension, approximately 10% of hypertensive population, remains a major concern associated with high morbidity and mortality. Recently, multiple novel pharmacotherapeutic approaches have been implicated in the management of hypertension on various pathophysiological mechanisms, including aldosterone synthetase inhibitors, RNA-based therapies such as antisense oligonucleotides and small-interfering RNA, atrial natriuretic peptide analogs, dual endothelin antagonists, intestinal sodium-hydrogen exchanger-3 inhibitors, compound 17b and nonsteroidal mineralocorticoid receptor antagonists.

Summary: Pharmacotherapeutic management options for hypertension is a growing field of research with potential clinical implications for multiple agents in upcoming years. Such novel approaches have the potential to improve clinical outcomes of hypertension management.

Keywords: aldosterone synthetase inhibitors; atrial natriuretic peptide analogs; baxdrostat; compound 17b; dual endothelin antagonists; hypertension; intestinal sodium-hydrogen exchanger-3 inhibitors; zilebesiran.