Understanding the latest strategies in hypertension management is crucial for effective patient outcomes, and emerging evidence underscores the need to identify hormonal drivers often overlooked in routine practice.
Despite widespread efforts to control blood pressure, primary aldosteronism remains a significant but under-recognized cause of hypertension, contributing to heightened cardiovascular risk when left undiagnosed. The Endocrine Society's 2025 Clinical Practice Guideline recommends universal screening for primary aldosteronism in all individuals diagnosed with hypertension to enhance detection rates and facilitate personalized treatment plans.
For patients with resistant hypertension attributable to excessive aldosterone production, the advent of Baxdrostat offers a novel treatment option. This aldosterone synthase inhibitor has demonstrated dose-dependent reductions in both systolic and diastolic pressures during early-phase trials. In the BrigHTN trial, patients receiving 2 mg of Baxdrostat experienced a mean systolic blood pressure reduction of 20.3 mm Hg, compared to 9.4 mm Hg in the placebo group, with a statistically significant difference (P<0.001).
Beyond pharmacology, optimizing the timing of antihypertensive agents can enhance therapeutic efficacy. A recent clinical trial from Sichuan University demonstrated that adopting a nighttime dosing strategy yielded an average nocturnal blood pressure reduction of 7 mm Hg and a daytime reduction of 5 mm Hg, aligning medication effects with circadian rhythms.
As screening guidelines evolve and treatment options expand, integrating systematic hormonal evaluation with targeted therapy and strategic dosing can transform care for patients with complex hypertension. Wider implementation of these practices promises to close persistent gaps in blood pressure management and reduce long-term cardiovascular complications.
Key Takeaways:- Primary aldosteronism is under-recognized but crucial for targeted hypertension management.
- Baxdrostat offers new avenues for patients with hormone-driven hypertension resistant to standard treatments.
- Bedtime dosing of antihypertensives may optimize blood pressure control throughout the day.
- As screening guidelines evolve, timely detection and intervention can improve overall patient outcomes.