Extended treatment with a new class of drugs can lower blood pressure for up to two years after medication stops in patients with hormone-driven hypertension, SciTechDaily reported.
Primary aldosteronism accounts for 5% to 10% of high blood pressure cases worldwide. Benign nodules in the adrenal glands produce excess aldosterone, forcing kidneys to retain salt and driving blood pressure upward. Surgery to remove an entire adrenal gland has traditionally been the only path to a cure.
Researchers at Queen Mary University of London tested extended aldosterone synthase inhibition, known as EASI, across eight centers in the United States. Patients took the experimental drugs for 6 to 12 months. Routine follow-ups tracked hormone levels and blood pressure after treatment ended.
For up to two years post-treatment, patient hormone levels and blood pressure remained lower than baseline measurements. The main marker of excess aldosterone stayed 99% below pretreatment levels. Blood pressure dropped by an average of 25 points, with almost a quarter of participants achieving normal blood pressure without any other medication.
Researchers and Investigators Assess the Findings
Mason Freeman, Professor of Medicine at Harvard Medical School and former medical director at Cincor, commented on the unexpected results. He initiated the original study.
“This follow-up study led by Dr. Brown has generated some extraordinary and unexpected findings,” said Mason Freeman, Professor of Medicine at Harvard Medical School. He added that the sustained remission “offers the very exciting possibility that many patients with primary aldosteronism may be able to be treated with a once-a-day pill, perhaps for a limited period of time.”
Morris Brown, lead author of the study, noted the historical context of the work. He pointed to a 2005 mouse experiment where deleting the gene responsible for aldosterone synthase caused the hormone-producing cells to disappear entirely.
“While duly cautious about our findings because of the pragmatic nature of the study, they were predicted by previous experiments, and longer follow-up may justify a claim that a finite course of medication leads to infinite cure,” said Morris Brown, lead author.
Regulatory Opinions and European Drug Review
Separate international developments target similar treatment paths for resistant hypertension. The European Medicines Agency’s human medicines committee recommended AstraZeneca’s blood pressure pill Baxfendy, also known as baxdrostat, for adults whose blood pressure remains high despite taking at least two other drugs, according to Tech Times.
Data reviewed by the committee show the medication outperforms a placebo. However, an independent US review by the Institute for Clinical and Economic Review rated that clinical edge promising but inconclusive, suggesting a fair price benchmark significantly below the drug’s current list price.
The research team is launching a larger prospective clinical trial named ELIXIR. This study will investigate whether EASI treatment can deliver a lasting cure for a wider group of patients.
The trial will employ molecular imaging of the adrenal glands to determine whether prolonged drug treatment actually eliminates aldosterone-producing cells in humans, mirroring the cellular changes observed in earlier animal models.
Frequently Asked Questions
What causes primary aldosteronism?
Benign nodules form inside the adrenal glands and produce excessive amounts of the hormone aldosterone. This excess hormone signals the kidneys to retain extra salt, which raises blood pressure significantly.
How long did blood pressure improvements last after stopping the trial medication?
Follow-up measurements showed that blood pressure and hormone suppression persisted for up to two years after patients stopped taking the experimental drugs.
What is the goal of the upcoming ELIXIR trial?
The ELIXIR trial will test a larger group of patients using molecular imaging to see if prolonged aldosterone synthase inhibition permanently destroys the hormone-producing cells in human adrenal glands.
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