[Aldosterone synthase inhibitors: a new group of drugs for influencing blood pressure in the renin-angiotensin-aldosterone system].

Despite the development of numerous drugs for the treatment of high blood pressure, there are still many difficulties in achieving successful treatment of patients with high blood pressure in routine clinical practice. The renin-angiotensin-aldosterone system plays a central role in blood pressure regulation and drugs such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers and mineralocorticoid receptor antagonists are used in routine treatment. For decades it was not possible to specifically inhibit the formation of aldosterone, a key hormone in blood pressure regulation but in recent years this has been very successfully achieved pharmacologically. Several so-called aldosterone synthase inhibitors are currently being tested in clinical trials, primarily in patients with uncontrolled or treatment-resistant hypertension. Of the active ingredients two (baxdrostat and lorundrostat) have already been shown to be very successful in phase 3 trials, demonstrating that the use of both drugs can further reduce systolic blood pressure by approximately 10 mm Hg in complicated blood pressure situations. The safety profile of the drugs has been unremarkable so far. As expected, blocking the formation of aldosterone increases potassium levels but this has not caused any clinically unmanageable problems. This is a promising group of drugs for the treatment of complicated blood pressure but also perhaps for early treatment.