The Lancet (Current)

[Comment] Aldosterone Synthase Inhibition in Resistant Hypertension: Promises and Unknowns

Resistant hypertension affects up to 20 % of hypertensive patients and carries heightened cardiovascular risk. Recent phase‑3 studies of aldosterone synthase inhibitors such as baxdrostat and lorundrostat have demonstrated significant ambulatory blood‑pressure reductions, positioning them as potential fourth‑line agents beyond traditional mineralocorticoid antagonists. The commentary highlights the therapeutic promise of directly curbing aldosterone synthesis while noting gaps in long‑term safety, renal outcomes, and optimal placement within guideline algorithms. These uncertainties temper enthusiasm until larger outcome trials are completed.