Reassessing the management of hypertension: Time to prevent aldosterone‐mediated heart failure

European Journal of Heart FailureEarly View Viewpoint Reassessing the management of hypertension: Time to prevent aldosterone-mediated heart failure Bertram Pitt, Bertram Pitt Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USASearch for more papers by this authorJenifer M. Brown, Jenifer M. Brown Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USASearch for more papers by this authorAnand Vaidya, Anand Vaidya Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USASearch for more papers by this authorJavier Diez, Corresponding Author Javier Diez [email protected] Center for Applied Medical Research (CIMA), and School of Medicine, University of Navarra, Pamplona, Spain Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain Corresponding author. Edificio CIMA, Av Pío XII 55, 31008 Pamplona, Spain. Email: [email protected]Search for more papers by this author Bertram Pitt, Bertram Pitt Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USASearch for more papers by this authorJenifer M. Brown, Jenifer M. Brown Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USASearch for more papers by this authorAnand Vaidya, Anand Vaidya Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USASearch for more papers by this authorJavier Diez, Corresponding Author Javier Diez [email protected] Center for Applied Medical Research (CIMA), and School of Medicine, University of Navarra, Pamplona, Spain Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain Corresponding author. Edificio CIMA, Av Pío XII 55, 31008 Pamplona, Spain. Email: [email protected]Search for more papers by this author First published: 18 January 2024 https://doi.org/10.1002/ejhf.3141Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1Diez J, Butler J. Growing heart failure burden of hypertensive heart disease: A call to action. Hypertension 2023; 80: 13–21. https://doi.org/10.1161/HYPERTENSIONAHA.122.19373 10.1161/HYPERTENSIONAHA.122.19373 CASPubMedGoogle Scholar 2 World Health Organization. Global report on hypertension: The race against a silent killer. Geneva: WHO; 2023. Google Scholar 3Díez J, Rosano G, Butler J. Time to reconsider the perception and management of hypertensive heart disease. Eur J Heart Fail 2023; 25: 450–453. https://doi.org/10.1002/ejhf.2811 10.1002/ejhf.2811 PubMedWeb of Science®Google Scholar 4Cannone V, Buglioni A, Sangaralingham J, Scott C, Bailey KR, Rodeheffer R, et al. Aldosterone, hypertension, and antihypertensive therapy: Insights from a general population. Mayo Clin Proc 2018; 93: 980–990. https://doi.org/10.1016/j.mayocp.2018.05.027 10.1016/j.mayocp.2018.05.027 CASPubMedWeb of Science®Google Scholar 5Baudrand R, Vaidya A. The low-renin hypertension phenotype: Genetics and the role of the mineralocorticoid receptor. Int J Mol Sci 2018; 19:546. https://doi.org/10.3390/ijms19020546 10.3390/ijms19020546 PubMedWeb of Science®Google Scholar 6Brown JM, Siddiqui M, Carey R, Siddiqui M, Williams GH. The unrecognized prevalence of primary aldosteronism: A cross-sectional study. Ann Intern Med 2020; 173: 10–20. https://doi.org/10.7326/M20-0065 10.7326/M20-0065 PubMedWeb of Science®Google Scholar 7Brown JM, Robinson-Cohen C, Luque-Fernandez MA Allison MA, Baudrand R, Ix JH, et al. The spectrum of subclinical primary aldosteronism and incident hypertension: A cohort study. Ann Intern Med 2017; 167: 630–641. https://doi.org/10.7326/M17-0882 10.7326/M17-0882 PubMedWeb of Science®Google Scholar 8Inoue K, Goldwater D, Allison M, Seeman T, Kestenbaum BR, Watson KA. Serum aldosterone concentration, blood pressure, and coronary artery calcium: The Multhi-Ethnic Study of Atherosclerosis. Hypertension 2020; 76: 113–120. https://doi.org/10.1161/HYPERTENSIONAHA.120.15006 10.1161/HYPERTENSIONAHA.120.15006 CASPubMedWeb of Science®Google Scholar 9Gray Z, Tu W, Chertow GM, Bhalla V. Aldosterone sensitivity: An opportunity to explore the pathogenesis of hypertension. Am J Physiol Renal Physiol 2021; 320: F325–F335. https://doi.org/10.1152/ajprenal.00415.2020 10.1152/ajprenal.00415.2020 CASPubMedGoogle Scholar 10Brown JM, Wijkman MO, Claggett BL, Shah AM, Ballantyne CM, Coresh J, et al. Cardiac structure and function across the spectrum of aldosteronism: The Atherosclerosis Risk in Communities study. Hypertension 2022; 79: 1984–1993. https://doi.org/10.1161/HYPERTENSIONAHA.122.19134 10.1161/HYPERTENSIONAHA.122.19134 CASPubMedGoogle Scholar 11Bauersachs J, López-Andrés N. Mineralocorticoid receptor in cardiovascular diseases – Clinical trials and mechanistic insights. Br J Pharmacol 2022; 179: 3119–3134. https://doi.org/10.1111/bph.15708 10.1111/bph.15708 CASPubMedWeb of Science®Google Scholar 12Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens 2023; 41: 1874–2071. https://doi.org/10.1097/HJH.0000000000003480 10.1097/HJH.0000000000003480 CASPubMedWeb of Science®Google Scholar 13Williams B, MacDonald TM, Morant SV, Webb DJ, Sever P, McInnes GT, et al. Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: The PATHWAY-2 mechanisms substudies. Lancet Diabetes Endocrinol 2018; 6: 464–475. https://doi.org/10.1016/S2213-8587(18)30071-8 10.1016/S2213-8587(18)30071-8 PubMedWeb of Science®Google Scholar 14Agarwal R, Ruilope LM, Ruiz-Hurtado G, Haller H, Schmieder RE, Anker SD, et al. Effect of finerenone on ambulatory blood pressure in chronic kidney disease in type 2 diabetes. J Hypertens 2023; 41: 295–302. https://doi.org/10.1097/HJH.0000000000003330 10.1097/HJH.0000000000003330 CASPubMedWeb of Science®Google Scholar 15Freeman MW, Halvorsen YD, Marshall W, Pater M, Isaacsohn J, Pearce C, et al.; BrigHTN Investigators. Phase 2 trial of baxdrostat for treatment-resistant hypertension. N Engl J Med 2023; 388: 395–405. https://doi.org/10.1056/NEJMoa2213169 10.1056/NEJMoa2213169 CASPubMedWeb of Science®Google Scholar 16Laffin LJ, Rodman D, Luther JM, Vaidya A, Weir MR, Rajicic N, et al.; Target-HTN Investigators. Aldosterone synthase inhibition with lorundrostat for uncontrolled hypertension: The Target-HTN randomized clinical trial. JAMA 2023; 330: 1140–1150. https://doi.org/10.1001/jama.2023.16029 10.1001/jama.2023.16029 CASPubMedGoogle Scholar 17Serenelli M, Jackson A, Dewan P, Jhund PS, Petrie MC, Rossignol P, et al. Mineralocorticoid receptor antagonists, blood pressure, and outcomes in heart failure with reduced ejection fraction. JACC Heart Fail 2020; 8: 188–198. https://doi.org/10.1016/j.jchf.2019.09.011 10.1016/j.jchf.2019.09.011 PubMedWeb of Science®Google Scholar 18Selvaraj S, Claggett B, Shah SJ, Anand I, Rouleau JL, Desai AS, et al. Systolic blood pressure and cardiovascular outcomes in heart failure with preserved ejection fraction: An analysis of the TOPCAT trial. Eur J Heart Fail 2018; 20: 483–490. https://doi.org/10.1002/ejhf.1060 10.1002/ejhf.1060 CASPubMedWeb of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation