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Resistant hypertension — needing four or more BP meds to stay controlled — affects millions and carries the highest cardiovascular risk of any condition. At the Cardiometabolic Health Congress, experts highlighted a growing toolkit: two newly approved drugs (aprocitentan and baxdrostat), a pending FDA decision on lorundrostat, and renal denervation devices that can cut systolic BP by up to 10 mm Hg.
Hypertension is the world's No. 1 killer — outpacing cholesterol, obesity, smoking, and even communicable diseases — and it affects one in two adults. The toughest cases, known as resistant hypertension (requiring four or more medications to control), carry the highest cardiovascular risk of all. At the Cardiometabolic Health Congress in Boston, Dr. Naomi Fisher of Brigham and Women's Hospital laid out the current treatment ladder and what's coming next.
The standard first three drug classes remain ACE inhibitors/ARBs, calcium channel blockers, and diuretics, with spironolactone as the go-to fourth agent. Beyond that, treatment gets individualized — and clinicians are urged to investigate secondary causes like primary aldosteronism, chronic kidney disease, or sleep apnea. Two newer drugs have now entered the picture: aprocitentan (a dual endothelin receptor antagonist) and baxdrostat (an aldosterone synthase inhibitor), with a third — lorundrostat — awaiting an FDA approval decision. Renal denervation devices round out the options.
Key Takeaways:
Why it matters: With 10 million people dying annually from hypertension-related causes, expanding the treatment arsenal for resistant cases isn't just a clinical win — it's a public health imperative.
