Hypertension

Panelists discuss how endothelin receptor antagonism addresses resistant hypertension by blocking one of the most potent vasoconstrictors, reducing smooth muscle hypertrophy and fibrosis, with aprocitentan being the only endothelin receptor antagonist approved for resistant hypertension.

BaxHTN trial results showed baxdrostat led to a significant reduction of systolic blood pressure compared to placebo, with a favorable safety profile.

Treatment with baxdrostat resolved or reduced the severity of hypertension, excessive aldosterone production, and hypokalemia in the phase 2a SPARK trial.

A panelist discusses how healthcare providers must become lifestyle coaches who understand patients' daily routines and circumstances to develop realistic medication schedules that address practical barriers to adherence in complex polypharmacy regimens.

Panelists discuss how standard ACE therapy leaves multiple pathways unblocked in resistant hypertension, with spironolactone being the most evidence-based fourth-line therapy despite limitations, while emerging therapies target sympathetic nervous system overactivity, aldosterone excess, and endothelin-mediated vasoconstriction.

Panelists discuss how lifestyle modifications, particularly sodium restriction and plant-based diets, form the foundation of resistant hypertension management, with innovative approaches like teaching kitchens and food-as-medicine programs being more effective than traditional diet counseling.

A panelist discusses how treatment strategies progress from standard 3-drug regimens (thiazide diuretics, calcium channel blockers, and ACE inhibitors/ARBs) to fourth-line options like endothelin antagonists or aldosterone antagonists, while addressing information overload and the need for weight management drugs.

Our June 2025 recap highlights significant advancements in cardiology, including new drug approvals and pivotal trial results.

The results of the ZENITH trial have encouraged the expansion of sotatercept’s label to patients with prior background therapy.

Panelists discuss how patients with resistant hypertension should be referred to specialists after 3 to 6 months of unsuccessful treatment, emphasizing that while primary care providers can manage most hypertension cases, specialists with particular interest and experience are needed for complex cases.

Panelists discuss how resistant hypertension is defined as blood pressure remaining above 130/80 mm Hg despite 3 medications, including a diuretic, affecting 10% to 15% of hypertensive patients, and how to differentiate true resistance from pseudoresistance caused by adherence issues, improper measurement, white coat effect, and interfering medications.

A panelist discusses how comorbidities like obesity, diabetes, and kidney disease significantly contribute to resistant hypertension through mechanisms including dietary sodium excess, arterial stiffening, and hormonal disruption from the renin-aldosterone system

The Phase 3 HYPERION trial achieved its primary endpoint of lower time to clinical worsening, measured by a variety of related factors.

A panelist discusses how the underlying causes of resistant hypertension remain largely mysterious, though physicians must screen for secondary causes like cortisol-producing tumors or coarctation of the aorta while recognizing that some patients simply don’t respond to normally effective medications.

GMRx2 is now the first and only FDA-approved triple combination medication for use as an initial therapy in patients needing multiple drugs to lower blood pressure.

A panelist discusses how resistant hypertension is defined as persistently high blood pressure (>135/85 mm Hg) despite patients being on multiple antihypertensive medications and occurs in approximately 1 in 5 compliant patients.

New research suggests intensive blood pressure management may significantly benefit adults aged 80 and older, challenging previous treatment assumptions.

The FDA approves treprostinil inhalation powder, enhancing treatment options for patients with pulmonary arterial hypertension and interstitial lung disease.

FDA approves 12.5 mg chlorthalidone tablets, enhancing hypertension treatment options and aligning with clinical guidelines for better patient outcomes.

Patients provided with a Post-Acute Care Hypertension consultation and a method of daily medication reminders presented lower blood pressure on follow-up.

Data suggest that etripamil may be more effective than vagal maneuvers and oral prophylaxis, minimizing emergency department visits.

Orchestra BioMed’s Breakthrough Device designation could apply to nearly 8 million patients with uncontrolled hypertension and increased cardiovascular risk

Anemia can moderate the association between both conditions, increasing the risk of atherosclerotic cardiovascular disease.

Bhatt discusses his expectations for the future of cardiology in 2025, including GLP-1-RAs and the push towards combination therapy.

Ruff discusses his expectations for cardiology for the rest of 2025, including new research into GLP-1 receptor agonists.